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COMAR 10.09.24.05

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State of Maryland Medical Assistance Manual Revised July 2012

1. The U.S. public birth record must show birth in one of the 50 states, the District of Columbia, American Samoa, Swain’s Island, Puerto Rico (if born on or after January 13, 1941), U.S. Virgin Islands (if born on or after January 17, 1917), Northern Mariana Islands (if born after November 4, 1986), or Guam (if born on or after April 10, 1899). 2. A data match by DHMH with Vital Records birth records in Maryland or another state. In order to be used as 2nd level verification of citizenship, the birth certificate must have been issued before the person was 5 years old 3. Do not accept a souvenir birth certificate issued by the hospital. 4. If the document shows the individual was born in Puerto Rico, the U.S. Virgin Islands, Northern Mariana Islands, or Guam before the date given above, the individual may be a collectively naturalized citizen (see the requirements below for verification of collective Naturalization).

Official military record of service: The document must show a U.S. place of birth (e.g., form DD-214). Evidence of civil service employment by the U.S. government: The document must show employment by the U.S. government before June 1, 1976. Final adoption decree for a child born in the U.S.: The adoption decree must show

the child’s name and a U.S. place of birth. If the adoption is not yet finalized and

the state where the child was born will not release a birth certificate before the

adoption is final, a written certification from a state approved adoption agency

that shows the child’s name and U.S. place of birth is acceptable if it state that the

source of information is an original birth certificate. Certification of Report of Birth Abroad (DS-1350) o Department of State to U.S. citizens who were born outside the U.S. and acquired U.S. citizenship at birth. If the birth was recorded on a FS-240, a certified copy of the DS- 1350 is not issued by the Department of Sate in Washington, D.C. The DS-1350 is not issued outside the U.S. The DS-1350 contains the same information as the current version of the FS-240. Consular Report of Birth Abroad of a Citizen of the United States of America (FS240) o Issued by a U.S. Department of State consular office. A FS-240 can only be prepared at an American consular office overseas while the child is younger than 18 years old. Children born outside the U.S. to U.S. military personnel usually have this form. Certification of Birth Abroad (FS-545) o Issued by U.S. Department of State consulates before November 1, 1990 along with the prior version of the FS-240. In 1990, U.S. consulates ceased to issue the FS-545. Treat FS-545 the same as the DS-1350. U.S. Citizen Identification Card (I-197 or the prior I-179) o Formerly issued by the Immigration and Naturalization Service (INS). The I-179 was issued during 1960 -1973 and the I-197 during 1973- April 7, 1983 to naturalized U.S. citizens living near the Canadian or Mexican border who needed it for frequent border crossings. Although no longer issued, either form that was previously issued is still valid.