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Iowa Department of Inspections, Appeals & Licensing

DIA becomes DIAL!

On July 1, 2023, multiple programs across four agencies became part of the Iowa Department of Inspections and Appeals (DIA) as a new organizational structure for state government goes into effect. DIA is now the Department of Inspections, Appeals, and Licensing (DIAL). 

Direct Care Worker Registry for CNAs

Direct care workers (DCWs) are responsible for the care of thousands of clients, patients, residents, or tenants in health care facilities throughout Iowa. DCWs provide assistance with daily activities, administer medications, and ease the burden for Iowa's elderly and persons with disabilities. In Iowa, only certified nursing assistants (CNAs), also referred to as nurse's aides, are placed on the Direct Care Worker Registry.

CNAs may apply online to be added to the registry so they are eligible for work in an Iowa long-term care facility, and CNAs are only required to be on the registry if they are seeking employment in a long-term care facility (nursing home, skilled nursing facility, or a skilled or swing bed unit of a hospital).

CNAs may visit the Health Facilities Division website to see if they are currently active on the registry. Select “DCW Search” on the left side of the page, and search by Registry ID number, first or last name, city, or county.

To gain placement on the registry

  1. The CNA candidate must take and complete the 75-hour course.
  2. The candidate must pass both a written and a skills test within four months of their hire date.
  3. Both tests must be passed within three attempts. If a candidate does not pass the written OR skills test after three attempts, they must retake the 75-hour course AND begin a new testing cycle.
  4. Upon successful completion of the written and skills tests, registry staff will receive notice from the testing entity and the CNA will be placed on the registry. Processing time varies; please allow at least two weeks.

To remain active on the registry

The Centers for Medicare and Medicaid Services (CMS) requires that a CNA perform at least a day of nursing or nursing-related duties every 24 months. Additionally, long-term care facilities only are required to provide and CNAs are required to complete at least 12 hours of in-service training per year.

Long-term care facilities are the only entities mandated by state and federal law to verify eligibility and report qualifying employment to the registry. However, health care employment agencies that employ CNAs at long-term care facilities must also report hours for their employees working in long-term care facilities. Entities other than long-term care facilities (and health care employment agencies who staff CNAs in long-term care facilities) are not required by state or federal law to verify eligibility or report long-term care-eligible employment. However, the only way a CNA can remain active on the Iowa Direct Care Worker Registry is if their Iowa employer reports their hours to registry staff. 

Before the CNA's status on the registry expires, a long-term care facility or other qualifying federally-certified entity can report employment for a CNA by logging in to DIA's Health Facilities Database/Direct Care Worker Registry. Facilities should consider electronic verification of employment status at least yearly prior to their annual survey, but they may do so more often.

If an entity does not update CNA new hires as outlined, the registry will not accurately reflect the CNA’s current status.

The other entity types that can report a CNA's hours electronically to the Iowa Direct Care Worker Registry:

  • Hospices
  • Hospitals
  • Home health care agencies (HHAs)
  • Ambulatory surgical centers (ASCs)

Some other facilities or employers are not able to report CNA hours electronically. Administrators or directors of nursing for those facilities will need to provide to DIA a job description and an attestation letter on facility letterhead to registry staff showing the CNA has performed at least eight hours of paid, nursing or nursing-related duties. The employer must provide enough details to show that the CNA has met the long-term care employment guidelines.

Employers that cannot report CNA hours electronically via the Direct Care Worker Registry/Health Facilities database:

  • Assisted living programs (ALPs)
  • Intermediate care facilities (ICFs)
  • Residential care facilities (RCFs)
  • Group homes

Please note that a CNA cannot report their own hours to the registry, nor can the CNA provide a letter verifying employment from the employer to DIA directly.

Letters can be emailed to, faxed to 515.281.6259, or mailed to:

Iowa Direct Care Worker Registry
c/o Iowa Dept. of Inspections and Appeals
Lucas State Office Building, 3rd Floor
321 East Locust St.
Des Moines, Iowa 50319-0083

Once a CNA's status has changed from "active" to "expired" on the registry, the employer (facility administrator or director of nursing for any entity type) must send a letter to registry staff, on the facility's letterhead, which includes a testament that the CNA performed at least eight hours' worth of nursing or nursing-related duties while the CNA was in the facility's employment — after the date they were last verified, but before they expired on the registry (list the specific duties) — as well as the CNA's:

  • Full name
  • Registry ID number
  • Hire date
  • Separation date

Please note that a CNA cannot report their own hours to the registry, nor can the CNA provide a letter verifying employment from the facility to DIA directly.

Letters can be emailed to, faxed to 515.281.6259, or mailed to:

Iowa Direct Care Worker Registry
c/o Iowa Dept. of Inspections and Appeals
Lucas State Office Building, 3rd Floor
321 East Locust St.
Des Moines, Iowa 50319-0083

If a CNA performs no qualifying work for two years, the CNA will have to retake both competency tests to get their status updated on the registry and to be eligible to work in a long-term care facility in Iowa. Contact DIA for more information at, or by phone at 515.281.4077 or 515.281.0108.

Individuals who are found guilty of abusing, neglecting, or mistreating residents by a court of law or who have had a finding of abuse, neglect, mistreatment, or misappropriation of resident property will be designated as not eligible for employment on the registry.

When a CNA wants to transfer to Iowa from another state registry, they must complete the Iowa Direct Care Registry application. Processing time varies; please allow at least two weeks.

Or, CNAs may now apply online.

If you wish to transfer from Iowa to another state registry, please first contact the registry in that state. 

Because of the personally-identifiable information in these documents, applications for the Iowa registry and forms for transferring to other states will not be accepted via email. All paper forms must be faxed to 515.281.6259, or mailed to:

Iowa Direct Care Worker Registry
c/o Iowa Dept. of Inspections and Appeals
Lucas State Office Building, 3rd Floor
321 East Locust St.
Des Moines, Iowa 50319-0083

If a CNA has been married or divorced since they were placed on the registry, their last name may not be current in the database. It is a CNA’s responsibility to make sure that all of their personal information is up to date. To do so, they must be a registered user. Find out how to access your information on the registry here.

Registry cards are no longer mailed automatically. This is to protect CNAs from identity theft. Cards can be securely printed from the Iowa Direct Care Worker database, by either CNAs or Iowa facilities who are logged in with an account ID and password. 

In Iowa, nursing assistants hold certifications instead of licenses. DIA does not have copies of any direct care worker's CNA certificate. If a CNA needs a copy of their course completion certificate, they must contact the college or entity where they took their CNA course.

Potential employers, verification companies, and other states' registry staff can check the Iowa DCW Registry to verify the status of a CNA by first and last name, city, county of residence, and registry number. This registry number is the only unique identifying number that DIA can publicly share or confirm. Registry staff will not search by personally-identifiable information (e.g., date of birth or any part of a Social Security number); please do not email this type of information to the registry. CNAs or employers should not send personally-identifiable information (e.g., birth dates, SSNs, or photos/documents showing a driver's license, Social Security card, etc.) to the registry via email.

The Iowa CareGivers, an independent nonprofit organization, was founded in 1992 in response to the growing concerns about the shortage and high turnover rates of those who work in direct care such as certified nurse aides (CNAs) and home care aides (HCAs). The organization’s sole purpose is to support the direct care workforce so they, in turn, are there to support Iowans and their families during their times of need. It is built upon the guiding principles that a stable, well-educated, skilled, respected, and well-compensated direct care workforce is vital to the safety and wellbeing of all Iowans. Programs and services include statewide and regional educational conferences; newsletters and other resources; mentor, leadership, and other training opportunities; recruitment resources; recognition programs; and much more. To learn more about Iowa CareGivers and its programs visit Iowa CareGivers online.

See the Iowa CareGivers brochure or Programs & Services document.

The National Association of Health Care Assistants (NAHCA) is the professional association dedicated to certified nursing assistants and assisted living caregivers. Established in 1995, NAHCA’s mission is to elevate the professional standing of those it serves through recognition, advocacy, and education while building a stronger alliance with healthcare providers to maximize success and the delivery of quality care. In 2010, NAHCA introduced the NAHCA Virtual Campus of Care (NVCC) which provides access for all caregivers to state-of-the-art online learning. The curriculum designed for the NVCC was developed with caregivers in mind providing compliance courses, professional development and advanced certification training. NVCC is more than education; it is a resource for caregivers and a consultant for staff educators. For more information, visit or email​.