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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL Division of Welfare and Supportive Services C-405.4 Medical Assistance Manual GENERAL ELIGIBILITY REQUIREMENTS 15 Jul 01 MTL 01/15 EVIDENCE OF U.S CITIZENSHIP OR NATIONALITY n. Life, health, or other insurance record that indicates a U.S. place of birth. o. Official religious record recorded in the U.S. showing that the birth occurred in the U.S. p. School records, including pre-school, Head Start and daycare, showing the child’s name and U.S. place of birth. q. Federal or State census record showing U.S. citizenship or a U.S. place of birth. r. If the applicant does not have one of the documents listed he or she may submit an affidavit signed by another individual under penalty of perjury who can reasonably attest to the applicant’s citizenship and that contains the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized. Note: In December 2009, the government of Puerto Rico enacted Law 191 of 2009 which voided all Puerto Rican birth certificates issued prior to July 1, 2010. Effective October 30, 2010, all Puerto Rican birth certificates issued prior to July 1, 2010 will become voided. A voided Puerto Rican birth certificate may not be used to verify identity or citizenship for the Medical programs. Previously accepted Puerto Rican birth certificates will remain acceptable for Medicaid determinations made prior to November 1, 2010. There will be no need to re-verify citizenship or identity at recertification or review of eligibility. C-410 ACCEPTABLE VERIFICATION OF IDENTITY The agency must accept the following as proof of identity, provided such document has a photograph or other identifying information, including, but not limited to, name, age, sex, race, height, weight, eye color or address. The following documents can be accepted as proof of identity when required as part of citizenship documentation. Identity documentation is not a separate requirement from citizenship documentation; it is a form of documentation used to verify citizenship or immigration status when using secondary evidence paper verification sources. • Driver’s license issued by the State or Territory either with a photograph of the individual or other identifying information of the individual such as name, age, sex, race, height, weight or eye color.