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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 October 2013 Subchapter Subject Page ending with Page M0220.000 CITIZENSHIP & ALIEN REQUIREMENTS Appendix 1 2

• Two documents containing consistent information that corroborates an applicant’s identity. Such documents include, but are not limited to, employer identification cards, high school and college diplomas (including high school equivalency diplomas), marriage certificates, divorce decrees and property deeds or titles. • Finding of identity from a Federal or State governmental agency. The agency may accept as proof of identity a finding of identify from a Federal agency or another State agency, including but not limited to a public assistance, law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual b. Affidavit If the applicant does not have any document specified above and identity is not verified, the applicant may submit an affidavit signed, under penalty of perjury, by another person who can reasonably attest to the applicant’s identity. Such affidavit must contain the applicant’s name and other identifying information. The affidavit does not have to be notarized. 3. Documents that Verify Citizenship a. Documents The agency must accept any of the documents listed below as proof of U.S. Citizenship. Photocopies of original documents are acceptable. • Civil Service employment by the U.S. government prior to 1976 • Evidence of compliance with the Child Citizen Act of 2000 • Final adoption decree showing U.S. birth, or if adoption is not final, a statement from a State-approved adoption agency that shows the child’s name and U.S. place of birth • Homeland Security’s Systematic Alien Verification for Entitlements Database (used when individual has become a Naturalized Citizen but information did not show up in SSA database) • Northern Mariana Card for individuals born before 11/4/1986 ( I-873) • Office of Vital Records • Official Military Records showing a U.S. birth Report/Certificate of birth abroad of U.S. citizen (dS-1350, FS-240 or FS-545) • U.S. Birth Certificate • U.S. citizen ID card (I-197 or I-179)