Pursuant to 561 Iowa Administrative Code Chapter 10, Waivers or Variances from
Administrative Rules, a petitioner must provide comprehensive justification of a proposed request for a waiver or variance to an administrative rule as adopted by the Department.
This form will assist you in providing all pertinent information that is necessary for the Department to grant a waiver or variance. The form must be submitted to the Department and must contain an adequate amount of factual and concise
information. The obligation rests with the petitioner to provide convincing evidence to justify the granting of a waiver or variance. You may provide additional information or attach additional pages if needed. The Department
reserves the right to require additional information to further support request
for a waiver or variance.
LQB Waiver/Variance Request Form (542-0004)