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Medical Services – Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration

Revised (05/18) • An official military record of service showing a U.S. place of birth. • A Northern Mariana Identification Card (issued by the USDHS to a collectively naturalized citizen of the United States who was born in the Northern Mariana Islands before November 4, 1986). Third level documentation– Third level evidence of U.S. citizenship is documentary evidence of satisfactory reliability that is used when neither primary nor secondary evidence of citizenship is available. This documentation includes: • Extract of U.S. hospital record of birth established at the time of the person’s birth, created at least 5 years before the initial application date and indicating a U.S. place of birth. • Life or health or other insurance record created at least 5 years before the initial application date showing a U.S. place of birth. • Religious records recorded in the U.S. within 3 months after the birth which show that the birth occurred in the U.S. showing the date of the birth of the individual or the individual’s age at the time the record was made. These must be official records recorded with the religious organization (e.g., baptismal certificates). Entries in a family bible are not considered recorded religious records. • Early school records which show the name of the child, the date of admission to the school, the date of birth (or age at the time the record was made), a U. S. place of birth, and the name(s) and place(s) of birth of the applicant’s parents. Fourth level documentation – Fourth level evidence of U.S. citizenship is documentary evidence of the lowest reliability. This level should only be used in the rarest of circumstances. This level of evidence is used only when primary evidence is not available, both secondary and third level evidence do not exist or cannot be obtained within the reasonable opportunity period, and the applicant alleges a U.S. place of birth. This documentation includes: • Federal or State census record showing U.S. citizenship or a U.S. place of birth, as well as the applicant’s age. • Birth records that were recorded with vital statistics 5 years after a birth (a delayed birth record). • Institutional admission papers from a nursing home, skilled nursing care facility or other institution created at least 5 years before the initial application date and which indicate a U.S. place of birth.