1. U.S. passport;
2. Certificate of Naturalization (DHS Forms N-550 or N-570);
3. Certificate of U.S. citizenship (DHS Forms N-560 or N-561);
4. Receipt of Supplemental Security Income (SSI) as shown on SDX interface;
5. Receipt of Social Security Disability Insurance (SSDI) as shown on BDE interface;
6. Documentation of child receiving foster care or adoption assistance payments under Title IV-B or IV-E:
7. Eligibility of a newborn for Medicaid in the month of his/her birth;
8. Entitlement to or enrollment in Medicare as shown on BDE interface;
9. Certificate of Indian Blood, or other U.S. American Indian/Alaska Native tribal document;
10. Any identity document described in section 274A(b)(1)(D) of the Immigration and Nationality Act to include;
a. Driver’s license issued by a U.S. State or Territory either with a photograph of the individual or other identifying information such as name, age, sex, race, height, weight or eye color.
b. School identification card with a photograph of the individual;
c. U.S. Military card or draft record;
d. Identification card issued by the federal, state, or local government with the same information included on driver’s licenses such as name, age, sex, race, height, weight, or eye color;
e. Military dependent’s identification card;
f. Native American Tribal document;
g. U.S. Coast Guard Merchant Mariner card
11. School record that shows date and place of birth and parent(s)’ name;
12. Clinic, doctor or hospital record showing date of birth;
13. Day care or nursery school record showing date and place of birth;
14. Religious record (cradle roll, naming certificate, baptismal record, Amish or Mennonite bishop’s letter);
15. Life insurance policy for the child showing in addition to the child’s name, the child’s age or date of birth.
Note: For children under 16, school records may include nursery or daycare records. If none of the above documents in the preceding charts are available, an affidavit may be used. An affidavit is only acceptable if it is signed under penalty of perjury by a parent or guardian stating the date and place of the birth of the child and cannot be used if an affidavit for citizenship was provided. The parent’s signature on the HHSS application for assistance meets the requirement for this affidavit.
{12/1/2009}