Table VI - Verification and Interface Match

Effective Date: July 1, 2026

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The eligibility agency must attempt to verify all factors of eligibility electronically before asking client to provide hard copy verifications. 705 outlines the various methods of verification.

This table shows the interface matches that are available and gives EXAMPLES of hard copy verifications that may verify the information

you need, although not every example listed will verify all of the information shown under the Eligibility Factors column. Any other

reasonable method of verification can be used as long as it provides the information needed to determine eligibility.

Eligibility Factor Interface or Match Other U.S. Citizenship; Age; Identification Electronic Interface SCHIP See Table IV Non-Citizen (INS) Status Electronic Interface - Social Security screens, Alien Registration Alien Registration Card Correspondence from the Department of Homeland Security Social Security Number; Social Security Claim # Electronic Interface Birth Record SAVE SCHIP SOLQ Social Security Card SSA form 5028 or 2880 Birth Certificate showing SSN applied for Official Social Security document Utah Residence; Resident of an Institution Electronic Interface New Hire Registry Prisoner System Information NCOA (National Change of Address USPS interface) Current Utah Driver’s license Employment payroll check stubs Current UTES registration House payment receipt Current rent receipt Utah telephone book listing (referenced) Tribal Record correspondence Children's residence usually follows that of parents Nursing home resident (unless placed by another state) Form 131- Affidavit of Intent to Become a Utah Resident; or other statement of intent to remain in Utah. Duty of Support Relationship (Including Specified Relative); Paternity Electronic Interface, Birth Record Self-declaration of relationship (unless the agency has conflicting information) Birth Certificate Court Order Marriage Certificate DWS Form 941 - Acknowledgment of Paternity “Voluntary Declaration of Paternity” form filed with Vital Statistics County Records Adoption placement or finalization forms (placement forms may be used to determine that child is not with birth parents) Death records Divorce records Documents from other state agencies stating verified relationship Duty of Support Completed Application for Child Support Enforcement on each non-custodial parent Pregnancy Self-declaration (unless the agency has conflicting information) Current physician's or nurse mid-wife’s statement Current statement from Planned Parenthood Statement from a health clinic School Attendance DWS form 126 Telephone contact with school Application for Other Benefits Electronic Interface - Paris (VA income), Workers Comp, Social Security, Unemployment Statement from other agency American Indian/Alaska Native or descendents in the 1st or 2nd degree of a Federally recognized tribe member. * Copayment exemption requires verification of status after the client has had reasonable time to provide verification. American Indian/Alaska Native (AI/AN) Tribal Identification/Enrollment Card with number/tribal census document issued by a federally recognized tribe indicating the individual's affiliation with the tribe. Certificate of Degree of Indian or Alaska Native Blood (CDIB) signed by the Bureau of Indian Affairs (BIA), or another document from BIA recognizing the person as American Indian/Alaskan Native. Tribal court documents containing identifying information such as name and the date of birth. Indian Health Services (IHS) document indicating the individual is eligible for IHS services as an American Indian/Alaskan Native. (Such documents must have identifying information about the individual. IE, name and date of birth.) AI/AN Descendent Documents of ascendent (parent or grandparent) that verifies status as member of federally recognized AI/AN tribe. Provider document: Birth certificate, tribal court document or IHS face sheet showing lineal descent from ascendant to descendant. Earned Income Note: When a more current data source is not available, verified income data that was received within the past six months at a SNAP or TANF determination may be used. Wages; Self-Employment Electronic Interface, Wages Work Number, Wages TRUV, the Hub New Hire Registry Employment payroll check stubs Employer's wage record Statement from employer Self-employment records Copy of most recent tax return SNAP and TANF income data received within the last six months Training, Work Study Award letter Contracts Earned income in-kind (food, clothing, free housing, etc.) Employer's records Statement from employer Written agreement Unearned Income Note: When a more current data source is not available, verified income data that was received within the past six months at a SNAP or TANF determination may be used. Social Security Benefits (SSA); Supplemental Security Income (SSI); VA Benefits; Retirement; Labor Union Benefits; Pensions; Annuity; Disability Compensation; Scholarships/loans; Tribal Income; Cash gifts and prizes Electronic Interface, Social Security Screens SOLQ (does not show correct amount if deductions are being taken out of benefits. Compare both the BDX and the SOLQ to verify the correct amount is counted.) Client statement of benefits until information appears on the SDX/BDX Award letter Legally acceptable copy of check Bank statement showing direct deposit specifying source of income Tribal Records SNAP and TANF income data received within the last six months Unemployment Compensation Electronic Interface, Unemployment Statement from DWS Bank statement showing direct deposit Alimony and Child Support Electronic Interface, Recovery Services screens County Clerk records Divorce decree or other court order about payments including judgment for past due amounts. Copies of checks received Statement from ORS Dividend and Interest Bank Statements, dividend letters or statements Currently posted saving passbook Current credit union statement Internet on-line banking Real Property Sales Sales Contract Mortgage Payment of household expenses by others Client's statement Form 702 - Statement of Contribution Form 17 - Statement of Head of Household Expenses Health Insurance Electronic Interface Receipt for health insurance premiums paid Insurance records/billing statement Check stubs/statements showing amount paid by individual Medicare Part A & B Premium Amounts Electronic Interface - Social Security screens Medicare Card Official document from SSA Alimony and Child Support Paid Out Electronic Interface, Recovery Services screens (Unemployment Claim Adjustment Field) Court order showing alimony or child support owed and copies of checks showing payments made Income tax records Medical bills owed Copies of medical services received and current statement of amount owed Statement from provider of amount owed Other TPL: Auto No Fault, Health (hospital), Accident, Homeowners Policies Insurance Card Written or verbal notice from ORS Client's statement Health Insurance Coverage Policies Insurance Card Written or verbal notice from ORS Client's statement