Citizenship and Identity Documents - Tier 1-4
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|Citizenship and Identity Verification Documents – T1 – T4 | |
|T1 Documents (Only Tier 1 documents are considered by the federal government to document both citizenship and identity). | |
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|US Passport. | |
|Enhanced Drivers license or state ID (only if issuing state verifies citizenship to issue enhanced document) | |
|Certificate of Naturalization. | |
|Certificate of Citizenship. | |
|Tribal Membership Card with picture. | |
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|T2 Documents | |
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|Official state/county US birth certificate. *** | |
|Other certification of birth issued by the Department of State. | |
|Department of Health (DOH) printout for Washington State Birth | |
|US Citizen ID card. | |
|Final adoption decree in the US. | |
|Evidence of civil service employment by the US government before June 1976. | |
|Official military record of service that shows a US place of birth. | |
|***NOTE: A "hospital" birth certificate is considered by the federal government to be a souvenir and DOES NOT meet the federal requirement for any "T" level of | |
|verification. | |
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|T3 - Examples | |
|The T3 tier of verification must be created 5 years before the date of initial application or eligibility review. | |
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|Religious records within 3 months of birth showing US place of birth. | |
|Early school record showing a US place of birth. | |
|Insurance company records (life or health), that indicate a US place of birth. | |
|US hospital record created at the time of birth, indicating a US place of birth such as: | |
|Chart notes of the birth. | |
|Hospital records of the baby's stay in the hospital. | |
|Other document that shows a U.S. place of birth that was created at least 5 years prior to the client’s initial application for Medicaid. | |
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|T4 - Examples | |
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|Federal or State census record indicating US citizenship or US place of birth. | |
|Institutional admission papers indicating a US place of birth and created 5 years before the date of initial application or review. | |
|Other medical records (clinic, doctor, or hospital), created five years before the date of initial application or review that indicate a US place of birth. | |
|Citizenship Affidavit (DSHSH 27-033) | |
|The Citizenship Documentation and Identity Declaration form (DSHS 13-789) does not fulfill this requirement. | |
|Clients exempt from citizenship requirements due to SSI, Medicare or receiving SSA disability if no level T1 or T2 exists. | |
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|Identity - Examples | |
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|A current state driver's license with individual's picture. | |
|A state identity card with individual's picture. | |
|A US American Indian/Alaska Native tribal document. | |
|Military identification card with individual's picture. | |
|For disabled individuals in residential care facilities the facility administrator or director may submit affidavits attesting to the client's identity. | |
|A child under the age of 16 (or 16-17 if they have no ID verification above) may present the following documents as evidence of identity: | |
|Citizenship Documentation and Identity Declaration form (DSHS 13-789) signed by the parent or guardian attesting to the child's identity. | |
|School record (including daycare and nursery school records) | |
|Clinic, doctor or hospital record. | |
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