307.07 Good Cause for Failure to Provide an SSN (MAM)

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An applicant may still be eligible for medical assistance, per 42 CFR 435.910, if the applicant:

• because of well-established religious objections, refuses to obtain a Social Security Number (SSN); or

• because the individual is ineligible for an SSN.

Well-Established Religious Objection

Proof that must be provided for a well-established religious objection:

• proof that the IRS has approved the individual’s submitted IRS Form 4029, Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits; OR

• both of the following:

- proof from the IRS that the individual has filed a waiver with the IRS using IRS Form 4029, Application for Exemption from Social Security and Medicare Taxes and Waiver of Benefits; AND

- a statement from a leader of the individual’s recognized religious sect or division.

The statement from a leader of the individual’s recognized religious sect or division must be on letterhead from that religious sect or division and:

• indicate that the individual is a member of this religious sect or division;

• state that the individual follows the tenets or teachings of this religious sect or division; and

• confirm that the tenets or teachings of this religious sect or division object to members getting an SSN.

The statement must also include:

• the religious leader’s printed name;

• the religious leader’s signature and the date the religious leader signed the statement; and

• contact information for the religious leader, including a phone number and address if this information is not already included in the letterhead on the statement.

A recognized religious sect or division must meet all the criteria at 26 CFR 1.1402(h)(e)(2).

Ineligible for an SSN

An individual who claims that he or she is ineligible for an SSN must provide proof from the Social Security Administration (SSA) of his or her ineligibility for an SSN.

References: He-W 625.01, RSA 167:4-c, RSA 167:79,iii(h), 42 CFR 435.910, 42 CFR 435.920, 45 CFR 205.52, 42 USC 1320b-7, 42 USC 405(c)(2)