TABLE IV - Proof of U.S. Citizenship and Identification

Effective Date: July 1, 2026

Previous Table

Clients who do not meet an exempt status as defined in Section 202 , and whose citizenship and identity are not verified through an electronic match must provide:

One document from Chart 1 as acceptable evidence of U.S. Citizenship and Identification; or

One document from Chart 2 as verification of Citizenship; and

One document verifying identity from Chart 3

Assist individuals who need to get proof of citizenship. Accept a photocopy, facsimile, scanned or other copy of a document unless information is inconsistent with other information in the case record or you question the validity of information on the document.

CHART 1

Accept any document in Chart 1 as stand-alone proof of citizenship and identity.

(Note: References to documents issued by the United States Citizenship and Immigration Services (USCIS) include documents issued by its predecessor, the Immigration and Naturalization Services (INS). On March 1, 2003, the former INS became part of DHS, and its naturalization function was assumed by U.S. Citizenship and Immigration Services (USCIS) within DHS. However, even documents issued after this date may bear INS legends.)

Stand-alone Documents Explanation U.S. Passport U.S. Passport Card The Department of State issues this. A U.S. passport/card does not have to be currently valid to be accepted as evidence of U.S. citizenship, as long as it was originally issued without limitation. Exception: Do not accept any passport as evidence of U.S. citizenship when it was issued with a limitation. However, such a passport may be used as proof of identity. Exception: As of November 1, 2010, do not accept an expired passport issued to a person born in Puerto Rico. Certificate of Naturalization (N-550 or N-570) Department of Homeland Security issues for naturalization. Certificate of Citizenship (N-560 or N-561) Department of Homeland Security issues certificates of citizenship to individuals who derive citizenship through a parent. A valid State-issued driver’s license that meets certain requirements The valid State-issued driver’s license may be used when: · The state issuing the license requires proof of U.S. citizenship, or · Obtains and verifies a social security number from the applicant who is a citizen before issuing the license. Verification of citizenship by a Federal Agency or another State. The verification must have been done on or after July 1, 2006. Example: child born to a Medicaid or CHIP eligible mother and the child received the one year of deemed newborn eligibility. Documentation from Federally Recognized American Indian Tribes, as published in the Federal Register by the Bureau of Indian Affairs . Examples include: Documents issued by a Federally recognized Indian tribe that identify the Federally recognized Tribe, the individual by name and confirms membership, enrollment or affiliation with the Tribe. Tribal Enrollment Card Certificate of Degree of Indian or Alaska Native Blood (CDIB) Tribal census document Documents on Tribal letterhead, issued under the signature of the appropriate Tribal official.

CHART 2

If an applicant does not provide documentary evidence from Chart 1, the following must be accepted as satisfactory evidence to establish citizenship if also accompanied by an identity document from Chart 3.

Evidence Explanation A U.S. public birth record showing birth in one of the 50 U.S. States; District of Columbia; American Samoa Swain’s island *Puerto Rico (if born on or after Jan. 13, 1941); Virgin Islands of the U.S. (on or after Jan. 17, 1917); Northern Mariana Islands (after Nov. 4, 1986 (NMI local time) Guam The birth record document may be issued by the State, Commonwealth, territory or local jurisdiction. Note : If the document shows the individual was born in Puerto Rico, the Virgin Islands of the U.S,,or the Northern Mariana Islands before these areas became part of the U.S., the individual may be a collectively naturalized citizen. Collective naturalization occurred on certain dates listed for each of the territories. Contact a Policy Specialist to verify these situations. Cross match with a State vital statistics agency documenting a record of birth Certification of Report of Birth (DS-1350) The Department of State issues a DS-l350 to U.S. citizens in the U.S. who were born outside the U.S. and acquired U.S. citizenship at birth, based on the information shown on the FS-240. When the birth was recorded as a. Consular Report of Birth (FS-240), certified copies of the Certification of Report of Birth Abroad (DS-1350) can be issued by the Department of State in Washington, D.C. The DS-1350 contains the same information as that on the current version of Consular Report of Birth FS-240. The DS-1350 is not issued outside the U.S. Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240) The Department of State consular office prepares and issues this. A Consular Report of Birth can be prepared only at an American consular office overseas while the child is under the age of 18. Children born outside the United States to U.S. military personnel usually have one of these. Certification of Birth Abroad (FS-545) Before November 1, 1990, Department of State consulates also issued Form FS-545 along with the prior version of the FS-240. In 1990, U.S. consulates ceased to issue Form FS-545, Treat an FS-545 the same as the DS-135O. United States Citizen Identification Card (I-197)or the prior version I-179 (Section 6036 referred to these documents in error as an I-97) INS issued the I-179 from 1960 until 1973. It revised the form and renumbered it as Form I-197. INS issued the I-197 from 1973 until April 7, 1983. INS issued Form I-179 and I-197 to naturalized U.S. citizens living near the Canadian or Mexican border who needed it for frequent border crossings. Although neither form is currently issued, either form that was previously issued is still valid. Northern Mariana Card (I- 873) The former Immigration and Naturalization Service (INS) issued the 1-873 to a collectively naturalized citizen of the U S who was born in the NMI before November 4, 1986 The card is no longer issued, but those previously issued are still valid. Final adoption decree The adoption decree must show the child’s name and U.S. place of birth. In situations where an adoption is not finalized and the State in which the child was born will not release a birth certificate prior to final adoption, a statement from a State approved adoption agency which shows the child’s name and U. S. place of birth is acceptable. The adoption agency must state in the certification that the source of the place of birth information is an original birth certificate. Evidence of civil service employment by the U.S. government The document must show employment by the U.S. government before June 1, 1976 through electronic verification. Official Military record of service The document must show a U.S. place of birth (for example a DD-214 or similar official document showing a U.S. place of birth) Data match with SAVE SAVE (Systematic Alien Verification for Entitlements) interface Evidence of meeting the automatic criteria for U.S. citizenship outlined in the Child Citizenship Act of 2000. See Section 202-1 Medical Records Includes, but not limited to: hospital, clinic, or doctor records or admission papers from a nursing facility, skilled care facility, or other institution that indicate a U.S. place of birth. Life, Health or other Insurance record showing a U.S place of birth Life or health insurance records may show biographical information for the person including place of birth; the record can be used to establish U S citizenship when it shows a U.S. place of birth. Religious records of birth Record must show the birth occurred in the U.S. The record must be an official record recorded with the religious organization. (Entries in a family bible are not considered religious records.) School record showing U.S. place of birth. The school record must show the name of the child and a U.S. place of birth . Federal or State census record showing U.S. citizenship or a U.S. place of birth Note: Census records from 1900 through 1950 contain certain citizenship information. To secure this information the applicant, recipient or State should complete a Form BC-600, Application for Search of Census Records for Proof of Age. Add in the remarks portion “U.S. citizenship data requested.” Also add that the purpose is for Medicaid eligibility. This form requires a fee. If the applicant does not have one of the documents from Chart 1 or any of the above documents from Chart 2, he may submit an affidavit signed by another individual The affidavit must be signed under penalty of perjury by the individual 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 need to be notarized.

CHART 3

Evidence of Identity

Documents to Establish Identify Explanation Any identity document described in 8 CFR 274a.2(b)(1)(v)(B)( 1 ) 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. Driver’s license issued by State or Territory. Do not accept a driver’s license issued by a Canadian government authority. School identification card U.S. military card or draft record Identification card issued by the Federal, State, or local government Military dependent’s identification card U S Coast Guard Merchant Mariner card For children under age 19 Clinic, doctor, hospital, or school record including preschool or day care records. Corroborating documents At state option, 2 or more documents containing consistent information corroborating an applicant’s identity such as marriage licenses, divorce decrees, high school or college diplomas, property deeds or titles, and employer ID. Finding of Identity from a Federal or State governmental agency Includes, but not limited to: public assistance, law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual. Finding of identity from an express lane agency as defined in section 1902(e)(13)(F) Link to 1902(e)(13)(F) If the applicant does not have one of the documents listed above, the applicant may submit an affidavit. The affidavit must be signed under penalty of perjury by the individual who can reasonably attest to the applicant’s identity, and that contains the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not need to be notarized.