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Identification card issued by Federal, State, or local government Must have the same information as is included on driver license. Institutional Care Affidavit (Form F-10175) If the applicant cannot produce the accepted documents verifying identity, a signed Statement of Identity for Persons in Institutional Care Facilities (F-10175) may be used. A residential care facility administrator signs this form under penalty of perjury attesting to the identity of a disabled individual in the facility. U.S. Military card or draft record, Military dependent’s identification card, or US Coast Guard Merchant Mariner card Must show identifying information that relates to the person named on the document. Medical record Doctor, clinic, or hospital records for children under age 19 only. Motor Vehicle Data Exchange This is a data exchange update with the Division of Motor Vehicles or when verifying an individual’s identity through the DOT Driver License Status Check website. Multiple Identity documents An individual may provide 2 or more corroborating ID documents to verify his/her identity. Examples include marriage license, divorce decree, high school or college diploma, or an employer ID card. Other MA Program Verified Identity An individual has already provided proof of identity while they were receiving Wisconsin Medicaid outside of CARES. For example, use this for members previously enrolled through the Katie Beckett program. State ID Paid by Agency Must have the same information as is included on driver license. School Identification card School identification card with a photograph of the individual or other identifying information. Written Affidavit for Children (Form F-10154) If the applicant cannot produce the accepted documents verifying identity for children under 18 years of age, a Statement of Identity for Children Under 18 Years of Age (F-10154) is acceptable. The affidavit must be signed under penalty of perjury by a parent, guardian or caretaker relative stating the date and place of birth of the child.

The affidavit does not have to be notarized. Written Affidavit (Form F-10161) If the applicant cannot produce the accepted documents verifying identity, a written affidavit may be used. The affidavit must:

Be signed under penalty of perjury by an individual other than the applicant, who can reasonably attest to the applicant’s identity.

Contain the applicant’s name, and other identifying information such as, age, sex, race, height, weight, eye color, or address. The affidavit doesn't need to be notarized. The "Identity Statement" section of the Statement of Citizenship and/or Identity form (F-10161) may be used for the affidavit.