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West Virginia Income Maintenance Manual Chapter 7

West Virginia Income Maintenance Manual Page 35 Chapter 7 Verification

Fourth Level Documents Explanation Federal or state census record showing U.S. citizenship or a U.S. place of birth. The census record must also show the applicant’s age. NOTE: Census records from 1900 through 1950 contain certain citizenship information. To secure this information, the applicant, client, or the Worker should complete a Form BC- 600, Application for Search of Census Records for Proof of Age. Add in the remarks portion “U.S. citizenship data requested.” The application should also include the purpose is for Medicaid eligibility. This form requires a fee. Other document as listed in the explanation that was created at least five years before the application for Medicaid or WVCHIP This document must be one of the following and show a U.S. place of birth: • Seneca Indian tribal census record • Bureau of Indian Affairs tribal census records of the Navaho Indians • U.S. State Vital Statistics official notification of birth registration • An amended U.S. public birth record that is amended more than five years after the person’s birth • Statement signed by the physician or midwife who was in attendance at the time of birth Institutional admission papers from a nursing home, skilled nursing care facility or other institution and was created at least five years before the initial application date and indicates a U.S. place of birth Admission papers generally show biographical information for the person including place of birth; the record can be used to establish U.S. citizenship when it shows a U.S. place of birth. Medical clinic, doctor or hospital record that was created at least five years before the initial application date and indicates a U.S. place of birth Medical records generally show biographical information for the person including place of birth; record can be used to establish U.S. citizenship when it shows a U.S. place of birth. NOTE: An immunization record is not considered a medical record for purposes of establishing U.S. citizenship. NOTE: For children under 16, the document must have been created near the time of birth or five years before the date of application. Roll of Alaska Natives Individuals were required to demonstrate U.S. Citizenship as part of the application process to be included on the Roll. It contains individuals who were born prior to December 17, 1971. Written Affidavit Affidavits may only be used in rare circumstances. An affidavit by at least two individuals, one of whom is not related