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).

• 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.

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 - Examples

The T3 tier of verification must be created 5 years before the date of initial application or eligibility review.

• 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 - Examples

• 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.

Identity - Examples

• 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.

Revised September 27, 2023

APPENDIX II

National Immigration Law Center (NILC) Guide

The National Immigration Law Center (NILC) publishes the "Guide to Immigrant Eligibility for Federal Programs, Fourth Edition". This appendix gives you access to sections of the NILC Guide, which contain descriptions and pictures of key citizenship and immigration documents, and information on how to decipher the coding on these documents.

• While this information was current as of the 2002 NILC Guide publication date, it is not a complete list of immigrant statuses and documents.
• Other types of immigrant eligibility questions should be submitted to the Policy Clarification Database through your Regional Financial Coordinator.

Revised September 20, 2011

APPENDIX VI

Click the following link to complete the SSN Request  used to request a non-work SSN from the Social Security Administration on behalf of clients applying for benefits.

• CSD Version - DSHS 14-517

Revised March 25, 2011

APPENDIX III

Statement of Hmong/Highland Lao Tribal Membership

I declare, under penalty of perjury, that I was a Hmong or Highland Laotian tribe member when the tribe assisted the U.S. military during the Vietnam era (8/5/64 to 5/7/75).

 

Signature

 

Date

Revised March 25, 2011

APPENDIX V

BARCODE PROCEDURES FOR REQUESTING WORK QUARTERS THROUGH THE SSA QUERY SYSTEM