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Page 4 of 5 § 10:69-3.9 AFDC-related Medicaid citizenship/eligibility requirements i. If an applicant presents an expired USCIS document or is unable to present any document demonstrating his or her immigration status, the CSSA shall refer the applicant to the local USCIS district office to obtain evidence of status. If, however, the applicant provides an alien registration number, but no documentation, the CSSA shall file USCIS Form G-845 along with the alien registration number with the local USCIS district office to verify status; ii. Lawful Permanent Resident-USCIS Form I-551, or for recent arrivals, a temporary I-551 stamp in a foreign passport or on Form I-94; iii. Refugee-USCIS Form I-94 annotated with stamp showing entry as refugee under section 207 of the Immigration and Nationalization Act and date entry into the United States; USCIS Form I- 688B annotated "274a. 12(a)(3)," I-766 annotated "A3," or I-571. Refugees usually adjust to Lawful Permanent Resident status after 12 months in the United States, but for purposes of determining Medicaid eligibility they are considered refugees. Refugees whose status has been adjusted will have USCIS Form I-551 annotated "RE-6," "RE-7," "RE-8" or "RE-9"; iv. Asylees-USCIS From I-94 annotated with a stamp showing grant of asylum under section 208 of the Immigration and Nationality Act, a grant letter from the Asylum Office of the U.S. Citizenship and Immigration Services, Forms-688B annotated "274a. 12(a)(5)" or I-766 annotated "A5"; v. Deportation Withheld-Order of an Immigration Judge showing deportation withheld under section 243(h) of the Immigration and Nationality Act and the date of the grant, or USCIS Form I- 688B annotated "274a. 12(a)(10)" or I-766 annotated "A10"; vi. Parole for at Least a Year-USCIS Form I-94 annotated with stamp showing grant of parole under section 212(d)(5) of the Immigration and Nationality Act and a date showing granting of parole for at least a year; vii. Conditional Entry under Law in Effect before April 1, 1980-USCIS Form I-94 with stamp showing admission under section 203(a)(7) of the Immigration and Nationality Act, refugee- conditional entry, or USCIS Forms I-688B annotated "274a. 12(a)(3)" or I-766 annotated "A3"; viii. Cuban Haitian Entrant-USCIS Form I-94 stamped "Cuban/Haitian Entrant under section 212(d)(5) of the INA"; ix. An American Indian born in Canada-USCIS Form I-551 with code S13 or an unexpired temporary I-551 stamps (with code S13) in a Canadian passport or on Form I-94; x. A member of certain Federally recognized Indian tribes--a membership card or other tribal document showing membership in tribe is acceptable documentation; or xi. Amerasian Immigration-USCIS Form I-551 with the code AM1, AM2, or AM3 or passport stamped with an unexpired temporary I-551 showing a code AN6, AM7 or AM8; 3. For aliens subject to the five-year waiting period before eligibility for Medicaid can be established, the date of entry into the United States shall be determined as follows: i. On USCIS Form I-94, the date of admission should be found on the refugee stamp. If missing, the CSSA should contact the USCIS local district office by filing Form G-845, attaching a copy of the document. ii. If the alien presents USCIS Form I-688B (Employment Authorization Document), I-766, or I-571 (Refugee Travel Document), the CSSA shall ask the alien to present Form I-94. If that form is not available, the CSSA shall contact the USCIS via the submission of Form G-845, attaching a copy of the documentation presented. iii. If the alien presents a grant letter or court order, the date of entry shall be derived from the date of the letter or court order. If missing, the CSSA shall contact the USCIS by submitting a Form G- 845, attaching a copy of the document presented.