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Sample Letters of Certification/Eligibility for Victims of a Severe Form of Trafficking

Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 October 2025 Subchapter Subject Page ending with Page M0220.000 CITIZENSHIP & ALIEN REQUIREMENTS Appendix 2 2

[Used For Children Under Age 18 Years]

HHS Tracking Number

(Address)

Dear :

This letter confirms that pursuant to section 107 (b) of the Trafficking Victims Protection Act of 2000, you are eligible for benefits and services under any Federal or State program or activity funded or administered by any Federal agency to the same extent as an individual who is admitted to the United States as a refugee under section 207 of the Immigration and Nationality Act, provided you meet other eligibility criteria. Your initial eligibility date is . This letter does not confer immigration status. You should present this letter when you apply for benefits or services. Benefit-issuing agencies should call the trafficking verification line at (866) 401-5510 to verify the validity of this document and to inform HHS of the benefits for which you have applied.

Sincerely,

[Signed] Director/Acting Director Office of Refugee Resettlement