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Page 4 of 7 § 10:71-3.3 Citizenship; alien status-documentation requirements ix. A contemporaneous hospital record of birth in one of the 50 states, the District of Columbia, Puerto Rico (on or after January 13, 1941), Guam (on or after April 10, 1899), the U.S. Virgin Islands (on or after January 17, 1917), American Samoa, Swains Island or the Northern Mariana Islands (unless the person was born to foreign diplomats residing in any of these jurisdictions); or x. Other documentation allowed through regulation by the Secretary of the U.S. Department of Health and Human Services in compliance with 42 U.S.C. §§ 1396b(x). 2. If an applicant presents an expired USCIS document or is unable to present any document demonstrating his or her immigration status, the county social service agency shall refer the applicant to the local INS district office to obtain evidence of status. If, however, the applicant provides an alien registration number, but no documentation, the county social service agency shall file USCIS Form G- 845 along with the alien registration number with the local INS district office to verify status. 3. The following sets forth acceptable documentation for eligible aliens: i. 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. ii. Refugee--USCIS Form I-94 annotated with stamp showing entry as refugee under section 207 of the Immigration and Nationality Act and date of 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." iii. Asylees--USCIS Form 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." iv. 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." v. 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. vi. 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." vii. Cuban Haitian Entrant--USCIS Form I-94 stamped "Cuban/Haitian Entrant under section 212(d)(5) of the INA." viii. An American Indian born in Canada--USCIS Form I-551 with code S13 or an unexpired temporary I-551 stamp (with code S13) in a Canadian passport or on Form I-94. ix. A member of certain Federally recognized Indian tribes--Membership card or other tribal document showing membership in tribe is acceptable documentation. x. Amerasian Immigrant--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. 4. 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 county social service agency should contact the USCIS local district office by filing Form G-845, attaching a copy of the document;