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Iowa Board of Pharmacy

sue.mears@iowa.gov

6200 Park Ave., Ste. 100 Des Moines, IA 50321

515-281-5944

Petition for Waiver Form

Please review the Board's rules governing waivers in 657 IAC Chapter 34 prior to filing a petition for waiver.  Deadline for inclusion on the Board's agenda is two weeks prior to a Board meeting. 

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    Contact Person for Petition for Waiver

    List each rule you are requesting to be waived (you must include the exact rule(s) or subrule(s) from 657 Iowa Administrative Code):

    List the time period for which you are seeking a waiver. The start date must be a future date. An end date must be requested.

    Start Date

    End Date

    Have you previously requested a waiver of any of the rules listed above?

    If a prior petition for waiver was granted or denied, attach a copy of the Board's prior written ruling or correspondence.

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    For each rule you are requesting to be waived, provide the following explanations:

    Have you spoken to a Board compliance officer or other member of Board staff about your request?

    Attach copies of any relevant email correspondence

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    Do you wish to participate in the Board meeting when this Petition will be considered?

    Attach any relevant documentation to support your answers.

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    Sign Here

    Choose how to sign

    Receipt

    You will be provided with a Receipt upon submission.