T1 Documents
Only Tier 1 documents are considered by the federal government to document both citizenship and identity.
US Passport.
Enhanced Drivers license or state ID (only if issuing state verifies citizenship to issue enhanced document)
Certificate of Naturalization.
Certificate of Citizenship.
Document from a Federally-recognized Tribe (such as Tribal Enrollment Card or certificate of degree of Indian blood).
T2 Documents
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.
T3 Documents
T3 documents must be created 5 years before the date of initial application.
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.
T4 Documents
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 Affidavit form does not fulfill this requirement.
Clients exempt from citizenship requirements due to SSI, Medicare or receiving SSA disability when no level T1 or T2 exists.
Identity Documents
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.
Three or more corroborating documents such as a marriage license, divorce decree, high school diplomas and employer Id cards to verify identity of an individual.
For disabled individuals in residential care facilities the facility administrator or director may submit affidavits attesting to the client's identity.
NOTE: Employer ID cards are not acceptable identity documents unless it is presented with 2 other corroborating documents listed above.
A child under the age of 16 only may present the following documents as evidence of identity:
DSHS Application or Eligibility Review with city and state of birth field completed and signed by the parent or guardian.
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.
Modification Date: April 30, 2009
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