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Special Assistance SA3240f1

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Figure 1 - ACCEPTABLE FORMS OF DOCUMENTATION OF CITIZENSHIP AND IDENTITY FOR U.S. CITIZENS

LEVEL 1 (EIS CODE 10)

DOCUMENT

LIMITATIONS, EXPLANATIONS, COMMENTS

U.S. Passport

May be expired. Not sufficient if issued with limitation(s); however, may be used for ID.

OTHERS: Certificate of Naturalization (N-550 or N-570); Certificate of Citizenship (N-560 or N-561)

LEVEL 2 (EIS CODE 25)

DOCUMENT

LIMITATIONS, EXPLANATIONS, COMMENTS

U.S. Public Birth Record

Shows birth in U.S., D.C., American Samoa, Swain’s Island, Puerto Rico (≥ 1/13/41), Virgin Islands (≥ 1/17/17), Northern Mariana Islands (> 11/4/86), Guam (≥ 4/10/1899)

    • Data match with the local Register of Deeds or State Vital Records; or copy of certified birth certificate (b.c.) is acceptable.

    • Must be issued by the state, commonwealth, territory or local jurisdiction prior to individual’s fifth birthday.

    • If born in Puerto Rico or Virgin Islands, individual may be collectively naturalized. See SA-3240, Figure 3 for more information.

DATA MATCH with database of other state agency which is known to verify citizenship

Includes Food Stamps, TANF (Work First), child support, child protective services.

Final Adoption Decree

Must show name and U.S. place of birth (POB).

Proof of Civil Service

Must show employment prior to 6/1/76.

Military Service Record

Must show a U.S. place of birth.

OTHERS: Certificate of Report of Birth (DS-1350); Consular Report of Birth Abroad of a Citizen of the U.S. (FS-240); Certificate of Birth Abroad (FS-545); United States Citizen Identification Card (I-197 or I-179); American Indian Card (I-872); Northern Mariana Card (I-873)

LEVEL 3 (EIS CODE 35)

DOCUMENT

LIMITATIONS, EXPLANATIONS, COMMENTS

Extract of hospital record on hospital letterhead

Must have been created at least 5 yrs before initial SA DOA and indicate U.S. POB. “Souvenir” b.c. issued by hospital not acceptable.

Life/health/other insurance record

Must show U.S. POB and have been created at least 5 yrs before initial SA DOA

LEVEL 4 (EIS CODE 45)

DOCUMENT

LIMITATIONS, EXPLANATIONS, COMMENTS

Federal/State Census

For persons born between 1900 and 1950. Must show U.S. Citizen or POB and age. See SA-3240 for info on how to obtain.

OTHERS: (Must have been created 5 yr < SA DOA & show U.S. POB) Seneca Indian tribal census; amended U.S. public birth record (amended > 5 yr after DOB); Statement from attending Dr/midwife who witnessed birth; Admission documents (NHM/SNF, other institutions); Medical record (clinic, doctor, hospital – not immunization record)

Written Affidavit

See MA-3330/2504 for specific requirements.

DOCUMENTATION OF IDENTITY – LEVEL 5

DOCUMENT

LIMITATIONS, EXPLANATIONS, COMMENTS

SOLQ or DATA MATCH w/other state agency

Food Stamps, TANF (Work First), child support, child protective services, motor vehicles, corrections, juvenile detention.

For children under 16, school records

Incl. nursery/daycare, clinic/doctor/hospital records w/DOB;

School , Military (incl dependent)ID or draft record

School ID must have photo.

ID issued by local, state or federal government

Must contain same info as a driver’s license.

OTHERS: Certificate of Degree of Indian Blood or other U.S. American Indian/Alaska Native tribal document (must have photo or other personal ID info); Native American Tribal Document; U.S. Coast Guard Merchant Mariner card; Affidavit (see limitations in SA-3240)

Note: Documentation of citizenship from Types 2, 3 and 4 also require documentation of ID from Type 5. Use Type 3 only when 1&2 are not available, do not exist or cannot be obtained w/in 45/90 days and a/r states he is a citizen. Type 4 should be used only rarely. See SA-3240 for detailed information regarding documenting citizenship/identity. Copies of all documentation must be obtained and placed in the Citizenship/Identity subfolder.

NOTE: All verifications must be copied and the copies placed in the Citizenship/Identity folder within the case file.

NAME OF INDIVIDUAL

DATE

DOC REQ

DATE DOC REC’D

METHOD OF DOCUMENTATION

(WRITE IN TYPE OF DOCUMENTATION USED AND PLACE COPY IN FILE)

EIS

CODE

     

SDX SOLQ

(CIRCLE ONE)

OR

TYPE 1

_______________

OR

TYPE 2 3 4

(CIRCLE ONE)

_______________________

AND

TYPE 5

_________________

 
     

SDX SOLQ

(CIRCLE ONE)

OR

TYPE 1

_______________

OR

TYPE 2 3 4

(CIRCLE ONE)

_______________________

AND

TYPE 5

_________________

 
     

SDX SOLQ

(CIRCLE ONE)

OR

TYPE 1

_______________

OR

TYPE 2 3 4

(CIRCLE ONE)

_______________________

AND

TYPE 5

_________________

 
     

SDX SOLQ

(CIRCLE ONE)

OR

TYPE 1

_______________

OR

TYPE 2 3 4

(CIRCLE ONE)

_______________________

AND

TYPE 5

_________________

 
     

SDX SOLQ

(CIRCLE ONE)

OR

TYPE 1

_______________

OR

TYPE 2 3 4

(CIRCLE ONE)

_______________________

AND

TYPE 5

_________________

 

ATTACH ADDITIONAL SHEETS WHEN NECESSARY. IDENTITY/CITIZENSHIP NEED ONLY BE DOCUMENTED ONCE UNLESS DOCUMENT(S) IS SUSPECT OR A HIGHER DOCUMENTATION TYPE BECOMES AVAILABLE. VERIFY ALIEN STATUS AT EACH APPLICATION AND REVIEW.

ALIEN STATUS VERIFICATION

NAME OF INDIVIDUAL

DATE VERIF REQ

DATE VERIFIED

TYPE OF VERIFICATION

(PLACE COPY IN FILE)

       
       
       
       
       

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