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7 • A U.S. passport, issued without limitations, even if it is expired. Please note, however, that passports issued to persons born in Puerto Rico must be current. Refer to IHCPPM, Section 2402.15.15 • A Certificate of Naturalization – N-550 or N-570 • A Certificate of Citizenship – N-560 or N-561 • Documentation from a federally recognized tribe. The document must identify the federally recognized Indian Tribe which issued it, identify the individual by name, and confirm the individual’s membership, enrollment in, or affiliation with that Tribe. Some examples include Tribal enrollment/membership cards, a certificate of degree of Indian blood issued by the Bureau of Indian Affairs, a Tribal census document, or a document issued by a Tribe indicating an individual’s affiliation with the Tribe. These documents are examples of documents that may be used, but do not constitute an all-inclusive list of such documents.

When any of the above documents are submitted as citizenship verification, no further proof of identity is required. Secondary sources of citizenship documentation are:

• A U.S. public birth certificate showing birth in one of the 50 States, District of Columbia, Puerto Rico (if born on or after January 1, 1941), Guam (if born on or after 1899), the U.S. Virgin Islands (if born on or after January 17, 1917), American Samoa, Swain’s Island, or the Northern Mariana Islands (if born after November 4, 1986) • A Certification of Report of Birth (DS-1350) • A Consular Report of Birth Abroad of a Citizen of the United States (FS-240) • A Certification of Birth Abroad (FS-454) • A United States Citizen Identification Card (I-197) • An American Indian Card (I-872) issued by the Department of Homeland Security with the classification code “KIC”. • A Northern Mariana Card (I-873) • A Final Adoption Decree showing the child’s name and place of birth in the U.S. • Evidence of civil service employment by the U.S. government before June 1, 1976 • An official military record of service that shows a U.S. place of birth.

The above sources are preferred secondary sources. The following two sources can be used only when the individual has provided a plausible reason as to why the preferred sources are not available: • An extract of a hospital record, on hospital letterhead, established at the time of birth, if created five years before the initial Medicaid application date. • A life, health or other insurance record showing a U.S. place of birth if created at least five years before the initial Medicaid application date.