Page 21

UNOFFICIAL 1714.1-21 (14) An official religious record recorded in the U.S. showing the birth occurred in the U.S.; (15) School records, including pre-school, Head Start and daycare, showing the child’s name and a U.S. place of birth; (16) A federal or State census record showing U.S. citizenship or a U.S. place of birth; (17) At the department’s option, a cross match with a State department of vital statistics documenting a record of birth; (c) If the individual does not have one of the documents listed in subsections (a) or (b), submission of an affidavit signed by another individual who can reasonably attest to the individual’s citizenship shall be accepted. The affidavit shall be signed under penalty of perjury and contain the individual’s name, date of birth, place of U.S. birth, and does not have to be notarized. (d) The department may rely on a verification of citizenship made by a federal agency or another State agency, without further documentation of citizenship or identity, if such verification was done on or after July 1, 2006. (e) The department shall provide assistance to individuals who need assistance in securing satisfactory documentary evidence of citizenship in a timely manner. (f) A photocopy, facsimile, scanned or other copy of a document shall be accepted to the same extent as an original document under this section, unless information on the submitted document is inconsistent with other information available to the department or the department otherwise has reason to question the validity of the document or the information on the document. (g) An individual unable to furnish the required documents or an affidavit shall not be eligible for medical assistance. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §§435.406, 435.407, 435.912, 435.930) (Imp: HRS §346-14; 42 C.F.R. §§435.406, 435.407, 435.912, 435.930)