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Life, health, or other insurance record Must show a U.S. place of birth. Medicaid Birth Claim When the Wisconsin Medicaid program pays the costs associated with the birth of an infant who either:

Did not qualify as a CEN, or

Was a CEN, but born before July 1, 2006 The infant will be considered a U.S. citizen who has met the citizenship documentation requirement. If citizenship is not verified through a data exchange, identity documentation is still required. Medical record (doctor, clinic, hospital) The document must show a U.S. birthplace. An immunization record is not considered a medical record for purposes of establishing U.S. citizenship. Official Military record of service The document must show a U.S. birthplace. Admission papers from nursing home, skilled nursing care facility, or other institution The document must show a U.S. birthplace. Other MA Program Verified Citizenship An individual has already provided proof of citizenship while they were receiving Wisconsin Medicaid outside of CARES. For example, use this for members previously enrolled through the Katie Beckett program. Birth Certificate Paid by IM Agency A U.S. public birth certificate (paid for by the Income Maintenance agency) showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after January 17, 1917), American Samoa, Swain’s Island, or the Northern Mariana Islands (after November 4, 1986). The birth record document may be recorded (previously 'issued') by the state, commonwealth, territory, or local jurisdiction. Religious Record or Baptismal Certificate An official religious record. The document must show a US birthplace and either the date of birth or the individual's age at time the record was made. Certification of Report of Birth The Department of State issues a DS-1350 to U.S. citizens in the U.S. who were born outside the U.S. and acquired U.S. citizenship at birth. Certification of Birth Abroad Form FS-545. Issued by the Department of State consulates prior to November 1, 1990. Consular Report of Birth Abroad of a US Citizen Form FS-240. The Department of State consular office prepares and issues this. Children born outside the U.S. to U.S. military personnel usually have one of these. Written Affidavit (Form F-10161) If the applicant cannot produce the accepted documents verifying U.S. citizenship, a written affidavit may be used. The affidavit must:

Be signed under penalty of perjury by a person other than the applicant who can reasonably attest to the applicant's citizenship.

Include the applicant's name, date of birth, and place of U.S. birth. The affidavit doesn't need to be notarized.