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The form collects personal details, prize amount, contact information, citizenship status, certification of sole ownership or authorized claiming, and VIP Club verification when applicable. 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For tax reporting, submit Federal Tax Form W-9 when required. The claim must also be made within the time frames specified by the game or promotion rules.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What additional documents are required if the prize is more than $600?",{"text":113,"@type":109},"Provide valid government-issued photo identification, such as a driver’s license or state ID card, military ID card, passport, or permanent resident card.",{"name":115,"@type":106,"acceptedAnswer":116},"What information is collected and how is the Social Security number handled?",{"text":117,"@type":109},"The form requires disclosure of the Social Security number for mandatory tax processing and cross-checking. 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Acceptable documents include driver’s licenses, state [I.D. cards](I.D. cards), military [I.D. cards](I.D. cards), passports, and permanent resident cards.  \n•Prizes must be claimed within the time frames specified by the rules for the game and/or promotion. Rules are available at [www.ialottery.com or](www.ialottery.com or) upon request.  \n•Additionally, if not a VIP Club entry:  \n-Sign the back of your winning ticket.  \n- If you are claiming a portion of this prize for someone else (such as your spouse or members of a group) you must identify all other winners entitled to any portion of this prize by filing Internal Revenue Service Form 5754 with us. Form 5754 is available from the Lottery. Questions should be discussed with your tax advisor.  \n1. NAME  (As it appears on Social Security card)  \n2. MAILING ADDRESS   UNIT  (No PO Boxes for merchandise)  \nCITY   STATE   ZIP    \n3. PHONE NUMBER   4. GENDER  M  F  \n5. SOCIAL SECURITY \\#   6. BIRTH DATE    \n7. PRIZE CLAIMED $ ~~ ~~ .00 8. EMAIL: optional   \n9. ARE YOU A U.S. CITIZEN?  YES  NO IF NO, are you a permanent U.S. resident?    \n10. I CERTIFY THAT  I am the sole owner of this ticket/entry OR  I am claiming this ticket on behalf of multiple winners.  \n11. Are you an employee/owner of a business holding a Lottery retailer license?  YES  NO  \nIF YES, name and address of business:    \n12. IF VIP CLUB ENTRY, the promotional prize verification number    \nWINNER CERTIFICATION: I certify that I am the sole owner of the lottery ticket/entry submitted with this form, or that I have been authorized by all other owners of this ticket/entry to claim the prize on their behalf. I also certify that 1) the purchaser of this ticket/entry was at least 21 years old or that, ifa gift, this ticket/entry was given to me by the purchaser, who was at least 21 years old; 2) that I have not altered this ticket/entry in any way; 3) that this ticket/entry is not stolen; 4) that I am not disqualified by law from receiving a prize from the Iowa Lottery and 5) that I am not subject to backup withholding due to incorrect tax identification number (TIN) submission. Parent or guardian must also sign ticket for any claimant who is a minor. Under penalties of perjury, I declare that to the best of my knowledge and belief that the information supplied on this form is true and correct and that I have correctly identified any other person who is entitled to any of these winnings.  \n13. PARENT/GUARDIAN’S SIGNATURE  DATE    \n(Only required if claimant is a minor. Persons under the age of 21 are excluded from winning any prizes through VIP Club promotions.)  \nBY SIGNING THIS CLAIM FORM, I agree to indemnify and hold harmless the state of Iowa and the Iowa Lottery, its elected officials, appointees, employees, agents and volunteers from any judgments, liabilities, losses, settlements or damages, including reasonable attorney’s fees incurred as a result of any untrue or inaccurate information which I have supplied in connection with claiming this prize.  \nBY SIGNING THIS CLAIM FORM, I authorize the Iowa Lottery to use my name and likeness for any publicity purposes that it deems desirable.  \n14. WINNER’S SIGNATURE   DATE    \nPursuant to Iowa Code Chapters 8A.504, 99G.38, 99G.41 and 421.","cbCaiaQj4ea6TVKH","https://ap.wps.com/l/cbCaiaQj4ea6TVKH","pdf",186108,"English","# Instructions to Winner\n# Winner Information\n## Personal details and prize details\n## Certifications and eligibility\n# Signatures and Privacy Act Notice","[{\"question\":\"What are the minimum requirements to claim an Iowa Lottery prize of $100 or more?\",\"answer\":\"Complete the winner claim form. For tax reporting, submit Federal Tax Form W-9 when required. The claim must also be made within the time frames specified by the game or promotion rules.\"},{\"question\":\"What additional documents are required if the prize is more than $600?\",\"answer\":\"Provide valid government-issued photo identification, such as a driver’s license or state ID card, military ID card, passport, or permanent resident card.\"},{\"question\":\"What information is collected and how is the Social Security number handled?\",\"answer\":\"The form requires disclosure of the Social Security number for mandatory tax processing and cross-checking. In a public records request, the Lottery redacts the Social Security number and birth date, and uses remaining information for research and publicity.\"}]","IOWA LOTTERY WINNER CLAIM FORM - Cash Prize Claim Instructions | PDF",1789811394]