Debi V. Durham, Director

Iowa Economic Development Authority

Qualifying BusinessCertification Process

Questions? Need assistance?

Contact Kristin Hanks, Program Manager at or 515.725.0440

Iowa Economic Development Authority

200 E. Grand Avenue

Des Moines, IA 50309

Application Instructions

To Complete Electronic Form: Click on TEXT BOX to add text.

  1. All Qualifying Businesses must complete the Qualifying Businessinformation sheet and submit the required documents.
  1. Before filling out this form, please read all applicable sections of the Iowa Code(Sections 15E.41-47) and Iowa Administrative Code (261 Iowa Administrative Code 115).
  2. Only typed or computer-generatedforms will be accepted and reviewed. Any material change to the format, questions, or wording of questions presented in this application will render the application invalid and it will not be accepted.
  3. Complete the applicable sections of the application fully. If questions are left unanswered or required attachments are not submitted, an explanation must be included.
  4. Any inaccurate information of a significant nature may disqualify the application from consideration.
  5. Please note that the Qualifying Business must be certified and registered as such before investors in the Business may be approved for the issuance of a tax credit.
  6. All information submitted is subject to Iowa’s Open Records law (Iowa Code, Chapter 22). If you have questions about Open Records, please contact the Program Manager.
  7. Please submit one copy of the form and all required documents to Kristin Hanks at or to the attention of Kristin Hanks at the address listed above. Facsimile copies will not be accepted.

Qualifying Business Information Sheet and Document Checklist

Name of Qualifying Business:

Name of Contact Person:

Qualifying Business’s Street Address:

Qualifying Business’sCity, State, Zip Code:

Contact Person’s Phone Number:

Contact Person’sE-mail Address:

Qualifying Business’sTaxpayer Identification Number:

Amount of Investment in the Qualifying Business at the time of submission of this form:

First Date on which equity investments qualifying for this investment tax credit have been made:

Does the business have an investor who holds at least a 70% ownership interest as an owner, member, or shareholder in the qualifying business on or after January 1, 2011?

Yes No

Is the business engaged primarily in retail sales, real estate, the provision of health care services or other services requiring a professional license? Yes No

In addition to the above information, Qualifying Businessesmust submit the following documents within 180 days from the first date on which the qualifying equity investments were made in order for an eligible Qualifying Business to be verified:

  1. A signed statement from an officer, director, manager, member, or general partner of the qualifying business that states the following:
  2. A description of the general nature of its business operations;
  3. The location of the principal business operations and the date on which the business was formed;
  4. The date on which the business commenced operations;
  5. A statement describing the manner in which at least one owner satisfies one of the training requirements set forth in the section “Training or Experience Requirements.” Please provide details such as number of years in applicable positions, names of companies, type of companies; educational institutions attended;
  6. A commitment by the Qualifying Business to amend the list of shareholders or equity holders in Exhibit B “as may be necessary from time to time to reflect new equity interests or transfer in equity among current equity holders or as any other information on the list may change.”
  7. A statement that certifies the existence of a business plan for the Qualifying Business which details the business’s growth strategy, management team, production/management plan, marketing plan, financial plan and other standard elements of a business plan
  8. Exhibit A-a balance sheet, certified by the Chief Executive Officer and the Chief Financial Officer for the Qualifying Business, that reflects the Qualifying Business’s assets, liabilities and owner’s equity as of the close of the most recent quarter.
  9. Exhibit B-The following information should be submitted in either a chart inserted in a Word document or in an Excel Spreadsheet or similar document with a separate column for each of the fields set forth below.
  10. Names of shareholders or equity holders
  11. Addresses
  12. Shares or equity interest issued
  13. Consideration paid for the shares or equity interests
  14. Amount of any tax credits that shareholders or equity holders may qualify for (equals amount of equity x 20%)
  15. Earliest year in which the tax credits may be redeemed-tax credits may not be redeemed prior to the third year after the qualifying investment was made, for instance, tax credits for qualifying investments made in 2013 will be eligible for redemption in 2016.

Training or Experience Requirements

The Qualifying Business must have an owner who has successfully completed one of the following:

  • An entrepreneurial venture development curriculum, such as programs developed by a John Pappajohn Entrepreneurial Center, or a holistic training program recognized by IEDA, which generally includes the following areas: entrepreneurial training, management team development, intellectual property management, market research and analysis, sales and distribution development, financial planning, and management and strategic planning;
  • Three years of relevant business experience;
  • A four-year college degree in business management, business administration or a related field; or
  • Other training or experience sufficient to increase the probability of success of the qualifying business.

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