Verification of Identity (when required)

Evidence of Identity (Any form of identity verification listed below is acceptable. The hierarchical approach is not required.)

Proof of identity is not required for qualified or undocumented immigrants.

A state driver’s license, Georgia Identification card or the Georgia Identification Card for Voting Purposes issued by the Department of Driver’s Services

Certificate of Indian Blood or other U.S. American Indian/Alaska Native tribal document

U.S. military card or draft record (must contain photo or other identifying information

Identification card issued by federal, state, or local government agencies or entities either containing a picture or identifying information such as name, date of birth, sex, height, color of eyes, and address (includes the Georgia Identification card issued by the County Voter Registrar’s office). Military dependent’s identification card if it contains a photograph or other identifying information

United States Coast Guard Merchant Mariner Card

School identification card with a photograph

U.S. passport issued with limitations

Data matches or documents from law enforcement or corrections agencies, such as police departments, sheriff’s departments, parole office, DJJ and Youth Detention Centers. Information such as height, race, date of birth, weight, eye color and/or other identifying information should be included. A print-out from their data system with identifying information would verify identity. Identifying information for former inmates can be accessed through the Georgia Department of Corrections at gdc.ga.gov/GDC/Offender/Query .

Form 3231 Immunization Record if an immunization date on the form was documented before the individual’s 16 th birthday. Refer to Appendix J for procedures for accessing the Georgia Registry of immunization Transactions and Services (GRITS) system.

3 or more documents that together reasonably corroborate the identity of an individual provided such documents have not been used to establish the individual’s citizenship and the individual submitted second or third tier evidence of citizenship. The worker must first ensure that no other evidence of identity is available to the individual prior to accepting such documents and document situation. Such documents must at a minimum contain the individual’s name, plus any additional information establishing the individual’s identity. All documents used must contain consistent identifying information, i.e., if a document is accepted that contains the name, DOB and address of the applicant/member, the other documents should contain the name, DOB and address of the applicant/recipient; or contain either the name and DOB; or the name and address. Identifying information includes full name, height, weight, eye color, DOB, current residential address, and photo identification. These documents include employer identification cards, high school and college diplomas from accredited institutions (including general education and high school equivalency diplomas), marriage certificates, divorce decrees and property deeds/titles. Data matches with the marriage, divorce, or death records of the state vital records index are also acceptable.

Disabled individuals in residential care facilities may have their identity attested to by the facility director or administrator when the individual does not have or cannot get any document on the preceding lists. Again, the affidavit is signed under penalty, but need not be notarized.

For individuals under age 16 who are unable to produce a document listed above, the following documents are acceptable to establish identity:

School record including report card, daycare, or nursery school record. (Must verify record with issuing school).

Clinic, doctor, or hospital record showing date of birth,

Form DMA-550 (Newborn certification) if it was created within 3 months of the child’s birth and is signed by a provider.

Form 219 Citizenship or Identity Affidavit (only used in rare circumstances as a last resort). Affidavit signed under penalty of perjury by a parent or guardian, stating the date and place of birth of the child and attesting to the identity of the child.

A signed Form 216 “ Declaration of Citizenship ” that includes the above information can be accepted to verify the child’s identity if he/she is under the age of 16. The identity remains verified even after the age of sixteen (16) and the applicant/recipient should not be asked to verify identity again if the Form 216 is in the current case record and documented.

An individual cannot use an affidavit for identity if he or she also submitted an affidavit for proof of birth or nationality.

Verification of identity is not required for deemed Newborns and is not required for EMA. A child who is deemed newborn is considered to have provided satisfactory proof of identity and is not required to provide any additional verification at CMD or future application for another Medical Assistance COA.

Verification of identity for adults and children can be verified by the following interfaces: FDSH SOLQ SDX BENDEX DDS