Submit Smoke Free Property Registry Information

Fill out the following form to submit your smoke free property to the website property registry.

IF YOU ARE SUBMITTING MORE THAN FOUR PROPERTIES DO NOT COMPLETE THIS ONLINE FORM, PLEASE EMAIL THE PROPERTY INFORMATION ALONG WITH THE INDIVIDUAL ADDRESSES TO smokefreehomes@idph.iowa.gov

Property Information

Property Name *

Property Address 1 *

Enter one street address. If you have multiple properties, submit the form for each property.

Property Address 2

City *

State *

Zip Code *

County *

Property Contact Phone Number *

Property Contact Email *

Housing Type *

Number of Smoke Free Units Available *

Are any residents currently allowed to smoke in their unit because they are exempt or grandfathered from the smoke free policy? *

Yes

Submit Lease

Use this link to submit a PDF copy of your lease by email. Please fill in the information as shown in the email. Remember to attach your lease file.

Submit Property Lease

If the email worked, skip to the next section.

Help Submitting Lease

Business Office Information

Property Management/Owner Name *

Management Address 1 *

Management Address 2

Management City *

Management State *

Management Zip Code *

Management Country *

Management Phone Number *

Management Email Address *

Are you an IDPH contractor or a property manager? *

IDPH Contractor

Property Manager/Owner

Does this property have accessible units that meet minimum ADA standards and Fair Housing Practices? *

Yes

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Submit Smoke Free Property Registry Information

Submit Lease