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UPDATED: NOVEMBER 2009 604

Category 1: U.S. Citizens continued Category Identity Documents (One identity document must be used with secondary, third or fourth level citizenship documentation). WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement U.S. Citizen (Includes the 50 U.S. States, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, and American Samoa, Swain’s Island and the Northern Mariana Islands for purposes of Medicaid eligibility.)

►A driver’s license issued by 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. Canadian driver’s licenses may not be used; ►School identification card with a photograph of the individual; ►U.S. military card or draft record; ►Identification card issued by Federal, State, or local government with the same information included on the driver’s license; ►Military dependent’s identification card; ►Certificate of Degree of Indian Blood, or other U.S. Native American/Alaska native tribal document with photo or other identifying information; ►U.S. Coast Guard Merchant Mariner card; ►A cross-match with a Federal or State governmental, public assistance, law enforcement, or corrections agency’s data system; ►If none of the above identity documents is available, a combination of three or more corroborating documents such as marriage certificates, divorce decrees, high school or college diplomas, employer ID cards or property deeds/titles. Voter registration cards are not acceptable; ►Disabled individuals in residential care facilities may have identity attested to by the facility director or administrator, on behalf of the individual in the facility, when the individual does not have or cannot get any document listed above. This affidavit must be signed under penalty of perjury but need not be notarized. ►Children under age 16 may have their identity documented using other means: ƒ Clinic, doctor or hospital record; ƒ School records including report card, day care or nursery school record. Records must be verified with the issuing school; ƒ Affidavit signed under penalty of perjury by a parent, guardian or caretaker relative stating the date and place of the child’s birth, if no other documents are available. An identity affidavit should not be used if a citizenship affidavit was used. Affidavits need not be notarized. Identity affidavits may be used for children under 18 when a school ID card or driver’s license is not available to the child until he or she is 18 years of age.

C

Not applicable to identity documents

Not applicable to identity documents

(MRG)