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Iowa Free Printable Rent Reimbursement Claim, 54-130 for 2024 Iowa Iowa Rent Reimbursement Claim

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Iowa Rent Reimbursement Claim
Rent Reimbursement Claim, 54-130

2021 Iowa Rent Reimbursement Claim Page 1 tax.iowa.gov Clear Form Name and address: • Complete using blue or black ink only. Do not use pencil or gel pen. • Incomplete claims will delay processing. You may be contacted for additional information. • Married couples living together are considered one household and can file only one claim, combining both incomes. If you do not live together, you may file separate claims. Print your last name, first name: Birth date (MMDDYYYY): SSN: Print spouse last name, first name: Birth date (MMDDYYYY): SSN: Current mailing address (Include unit number): ______________________________________________ City:________________________________________________ State: __________ ZIP:____________ Who is eligible: 1. Were you (or your spouse) born before 1957? ....................................................... Yes No 2. Were you (or your spouse) born between 1957 and 2003 and totally disabled? .... Yes No Include a copy of your letter that shows you are disabled from the Social Security Administration, Veterans Administration, your doctor, or Form SSA-1099. If you answered “no” to both questions 1 and 2, STOP; YOU DO NOT QUALIFY. 3. Did you live in Iowa during 2021? If “no,” STOP; YOU DO NOT QUALIFY. ........... Yes No 4. Do you currently live in Iowa? If “no,” STOP; YOU DO NOT QUALIFY. ................. Yes No Total annual household benefits and income: For you and your spouse even if not reported for Iowa individual income tax purposes. Send proof of income. 5. HUD, Section 8, and any portion of rent or utilities paid for you. ................ , .00 6. Title 19 benefits for housing only. ............................................................... , .00 If you lived in a nursing home or care facility, contact the administrator for amount to enter on line 6. Or, enter 20% of benefits if living in a nursing home or 40% if living in a care facility. 7. Gross Social Security income. Include SSI and Medicare premium withheld. ........... , .00 8. Gross disability income. Include SSDI, VA, and Railroad. Provide proof of disability. .... , .00 9. Wages, salaries, unemployment compensation, etc. ................................... , .00 10. All pension, IRA, and annuity income. Include military retirement pay ................. , .00 11. Interest and dividend income. ...................................................................... , .00 12. Profit from business/farming/capital gain. .................................................... , .00 13. Cash or checks received from others living with you. .................................. , .00 14. Other benefits and income........................................................................... , .00 Include child support, alimony, FIP, children’s SSI, welfare payments, gambling, etc. 15. Total annual household benefits and income. Add lines 5 through 14 ......... Is line 15 $24,354 or more? If yes, STOP; YOU DO NOT QUALIFY. 54-130a (06/28/2021) Continue on next page , 0 .00 2021 Iowa Rent Reimbursement Claim, Page 2 Rental information: Complete the Statement of Rent Paid if you lived in more than one place. No 16. Did you live in a nursing home or care facility? If yes, report Title 19 benefits on line 6. Yes 17. Rental address. The location where you lived must be subject to property tax. You are not eligible for rent reimbursement if the location or nursing home was not subject to property tax. Dates you rented in 2021 (MMDDYY): from to Total Iowa rent you paid at this location................................................... , .00 Street (PO Box not allowed): ______________________________________________________ City: __________________________________________ State: ZIP: Landlord or nursing home: Name: _________________________________________ Phone number: ( ) Address: ______________________________________________________________________ City: __________________________________________ State:_________ ZIP: ___________ If you lived in more than one location, complete the Statement of Rent paid for all other locations. 18. Total Iowa rent you paid in 2021. Add rent for all locations........................... , .00 This section optional: Complete lines 19 to 21 below, or allow the Department to compute for you. 0 .00 19. Rent eligible for reimbursement. Multiply line 18 by 0.23, enter result . ...... , If more than 1,000, enter 1,000. Example: if line 18 = 3,900, multiply 3,900 x 0.23 = Enter 897 on line 19 X 20. Select rate from table below based on total benefits and income on line 15: . $0.00 $12,546 $14,022 $15,498- $12,545.99 ....... enter 1.00 $14,021.99 ....... enter 0.85 $15,497.99 ....... enter 0.70 $18,449.99 ....... enter 0.50 $18,450 - $21,401.99 ....... enter 0.35 $21,402 - $24,353.99 ....... enter 0.25 $24,354 or greater....STOP; you do not qualify. 21. Estimated reimbursement. Multiply line 19 by line 20. ................................... , Example: line 19 = 897, multiply 897 by 0.70 = 628, enter on line 21. Direct deposit information: To receive direct deposit of your reimbursement to your account, complete lines A and B. A. Routing number: B. Account number: Type: Checking 0 .00 Savings I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this claim, and, to the best of my knowledge and belief, it is true, correct, and complete. If deceased, Your signature: Date: date of death: If deceased, Spouse signature: Date: date of death: Your phone number: ( ) Preparer phone number: ( ) Preparer name: Preparer signature: Date: ► Include proof of income and rent paid. If under 65, also include proof of disability. Mail to: Rent Reimbursement, Iowa Department of Revenue, PO Box 10459, Des Moines, IA 50306-0459. To check the status of a refund visit tax.iowa.gov or call 1-800-572-3944. Clear Form 54-130b (07/01/2021)
Extracted from PDF file 2021-iowa-form-54-130.pdf, last modified July 2020

More about the Iowa Form 54-130 Other Tax Credit

Form 54-130 requires you to list multiple forms of income, such as wages, interest, or alimony .

We last updated the Iowa Rent Reimbursement Claim in January 2022, and the latest form we have available is for tax year 2021. This means that we don't yet have the updated form for the current tax year. Please check this page regularly, as we will post the updated form as soon as it is released by the Iowa Department of Revenue. You can print other Iowa tax forms here.


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Other Iowa Other Forms:

TaxFormFinder has an additional 43 Iowa income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form 54-130 Iowa Rent Reimbursement Claim
Form 54-028 Homestead Property Tax Credit Application
Form 54-001 Iowa Property Tax Credit Claim
Form 54-024 Business Property Tax Credit Application
Form - TPM Participating Manufacturer Certification Form & Instructions

Download all IA tax forms View all 44 Iowa Income Tax Forms


Form Sources:

Iowa usually releases forms for the current tax year between January and April. We last updated Iowa Form 54-130 from the Department of Revenue in January 2022.

Show Sources >

Form 54-130 is an Iowa Other form. States often have dozens of even hundreds of various tax credits, which, unlike deductions, provide a dollar-for-dollar reduction of tax liability. Some common tax credits apply to many taxpayers, while others only apply to extremely specific situations. In most cases, you will have to provide evidence to show that you are eligible for the tax credit, and calculate the amount of the credit to which you are entitled.

Historical Past-Year Versions of Iowa Form 54-130

We have a total of five past-year versions of Form 54-130 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2021 Form 54-130

Rent Reimbursement Claim, 54-130

2020 Form 54-130

Rent Reimbursement Claim, 54-130

2019 Form 54-130

2019 Rent Reimbursement Claim, 54-130

2018 Form 54-130

Iowa Rent Reimbursement Claim

2017 Form 54-130

Iowa Rent Reimbursement Claim


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