SR 14-03 Dated 01/14

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

FROM OFFICE OF THE DIRECTOR, DFA:	Terry R. Smith
DFA SIGNATURE DATE:	December 18, 2013
AT (OFFICE):	Division of Family Assistance
TO:	District Office Supervisors
SUBJECT:	Changes to Citizenship and Identification Verification Requirements Based on Revisions to Federal Regulations; Revised DFA Form 800CITZ, Citizenship and Identity Acceptable Proofs
EFFECTIVE DATE:	January 1, 2014

SUMMARY

This SR releases policy requiring less restrictive documentation of citizenship/non-citizen status and identity for applicants of all categories of financial and medical assistance to incorporate changes:

· mandated by the Centers for Medicare and Medicaid Services (CMS) through proposed amendments to 42 CFR 435.407; and

· enacted by administrative rules promulgated at He-W 606.02 and He-W 606.28.

Earlier changes at the federal level and implementation of the Social Security Administration cross-match in August 2010 removed the burden on most applicants and recipients of financial and medical assistance to provide paper proof of citizenship and identity as a condition of eligibility (See DFA SR 10-31, dated 8/10, for more details). For those individuals who, per DFA SR 10-31, must provide paper proof of their citizenship and identity, the new less restrictive documentation requirements for verifying an individual’s citizenship and identity are as follows:

· Copied, faxed or scanned documents are now considered acceptable proofs;

· There are now only two levels of acceptable proofs;

· Documents from either of the 2 levels can be submitted as proof of identity and citizenship;

· A minimum of 2 documents with corroborating information are now acceptable proofs of identity, and prior approval from a District Office Supervisor is no longer necessary;

· Clinic, doctor, hospital, school and daycare records or report cards are acceptable proof of identity for children aged 19 and under;

· When citizenship or identity documents listed in DFA Form 800CITZ, Citizenship and Identity Acceptable Proofs, are unavailable, any individual can submit an affidavit, signed under penalty of perjury by another person attesting to the individual’s identity or citizenship, as follows:

- For identity: the affidavit is considered acceptable proof of identity if the affidavit contains the individual’s name and other identifying information such as their age, sex, race, height, weight, eye color. or address. The affidavit does not have to be notarized.

- For citizenship: only one affidavit is now required, and the affidavit is considered acceptable proof of citizenship if it is written by someone with knowledge of the individual’s citizenship and contains the individuals’ name, date of birth, and US birthplace. The affidavit does not have to be notarized; and

· Citizenship documents no longer have creation date restrictions.

The above policy changes required revisions to DFA Form 800CITZ, Citizenship and Identity Acceptable Proofs.

FORMER POLICY	NEW POLICY
Only original documents or copies certified by the issuing agency were considered acceptable proof of citizenship and identity.	Photocopied, faxed, or scanned documents are now considered valid proofs – unless: · the information on the copy is inconsistent with other information available to the agency; or · the validity of the copied document is questionable.
Only the documents listed in a 4-tiered chart with progressive levels of acceptability for verifying citizenship and/or identity were considered acceptable proofs.	There are now only 2 levels of acceptability for documents that verify citizenship and identity. Documents listed in the top level verify both citizenship and identity together. No other documentation is required to verify citizenship or identity. If applicants provide a citizenship document from the lower level, they must also provide a document from the list of acceptable identity proofs to verify citizenship.
Individuals could only provide citizenship documents from the lower numerically listed tiers if documents from the higher numerically listed tiers were unavailable.	Individuals can provide citizenship documents from either of the 2 levels of acceptable proofs.
If identity documents from the list of acceptable proofs were unavailable, applicants could verify their identity by providing a minimum of 3 documents together, containing their name and other consistent identifying information, if the documents had been previously approved by the DO Supervisor.	A minimum of only 2 documents together that contain the individual’s name and other consistent identifying information, is considered valid proof of identity. Prior approval by the DO Supervisor is no longer required.
Clinic doctor, hospital or school records, including daycare records and report cards, were acceptable proofs of identity for children aged 15 and under if the records were verified with the school.	Clinic, doctor, hospital, school and daycare records or report cards are considered acceptable proofs of identity for children aged 19 and under. School verification is no longer necessary.
To prove identity, disabled individuals in institutional care facilities had to provide an affidavit signed by the institution’s director or administrator on behalf of the individual.	When the documents listed as acceptable proofs of identity are unavailable, any individual can now submit an affidavit, signed under penalty of perjury, by another person who can attest to their identity. The affidavit must contain the individual’s name, and other identifying information, such as their age, sex, race, height, weight, eye color or address. The affidavit does not have to be notarized.
If all acceptable citizenship documents were unavailable, to prove citizenship, an individual was required to submit at least 2 affidavits from separate people who: · could not be related to the individual; · had to have personal knowledge of the events establishing the citizenship of the individual; and · could provide proof of their own citizenship and identity.	If an individual cannot provide citizenship documents from the list of acceptable proofs, the individual can now submit one affidavit, signed under penalty of perjury, by another person who has knowledge of and can attest to the individual’s citizenship. The affidavit must contain the individual’s name, date of birth and US place of birth. It does not have to be notarized.
Many citizenship documents were acceptable only if they had been created within certain time periods.	There are no longer limitations of time periods within which specific citizenship documents had to have been created.

POLICY

Documents listed in the chart below are considered acceptable forms of paper proof for citizenship/non-citizen status and identity for an individual applying for any category of financial or medical assistance, and who is unable to have his or her citizenship and identity verified through the current SSA electronic crossmatch.

Documents that are photocopied, faxed, or scanned are considered valid proofs, unless:

· the information on the copy is inconsistent with other available information; or

· the validity of the document or the information on the copied document is questionable.

CITIZENSHIP & IDENTITY ACCEPTABLE PROOFS

YOU MAY SUBMIT PHOTOCOPIED, FAXED, OR SCANNED DOCUMENTS

PROOFS TO VERIFY BOTH YOUR CITIZENSHIP and IDENTITY

IF YOU GIVE US ONE OF THE DOCUMENTS IN THIS SECTION,

YOU DO NOT HAVE TO GIVE US ANY OTHER DOCUMENTS TO VERIFY YOUR CITIZENSHIP AND IDENTITY.

US Passport or US Passport Card:

(valid or expired – if it was issued without limitation)

Certificate of Naturalization

Certificate of US Citizenship

“Enhanced” State Driver’s License

(from a state that verifies US citizenship before issuing the license. License must say “Enhanced Driver License”)

Documents Issued by a Federally Recognized Indian Tribe

Verification of Citizenship via a Federal or Another State Agency (if done on or after 7/1/06)

OR YOU CAN GIVE US:

1 DOCUMENT FROM COLUMN A and 1 DOCUMENT FROM COLUMN B

COLUMN A	COLUMN B
US Public Birth Certificate from one of the 50 states and DC; or PR, Guam, VI of the US, American Samoa, Swain’s Island, or CNMI (some date restrictions apply)	Picture Driver’s License (Issued only by a US state or Territory)
Certification of Report of Birth of US citizen	Picture School ID
Report of Birth Abroad of US citizen	US Military card or Draft Record
Certification of Birth	State, Federal, or local government ID Card
Birth Record Documented by Cross-Match with State Vital Statistics	Certificate of Degree of Indian Blood or Tribal Document with Picture
US Citizen ID Card	Military Dependent’s ID Card
Northern Mariana ID Card (birth prior to 11/4/86)	US Coast Guard Merchant Marine Card
Evidence of US Civil Service Employment (if employed prior to 6/1/76)	Voter’s Registration Card
Final Adoption Decree with child’s name and US birthplace (If the adoption is not final, a statement from a state-approved adoption agency showing child’s name and US birthplace.)	Proof of Identity Verified by a Federal or State Government Agency, such as: a Public Assistance, Law Enforcement, Internal Revenue, Tax Bureau, or Corrections Agency
US Military Record (showing US birthplace)	2 or more documents together, with your name and consistent identifying information, such as: Employer ID Cards High School/College diplomas HS equivalency diplomas Marriage Certificates Divorce Decrees Property Deeds/Titles
Data Verification with SAVE Program (or other Dept. of Homeland Security verification process)	Special Identity Rules for Children Aged 19 and Under: Clinic, doctor, hospital or school records, including pre-school or daycare records or report cards.
Proof of a child meeting the requirements in Section 101 of the Child Citizenship Act of 2000	If you do not have any of the identity documents listed above, you may submit an affidavit. It must be signed, under penalty of perjury, by another person who can attest to your identity. The affidavit must contain your name, and other identifying information, such as your age, sex, race, height, weight, eye color or address. The affidavit does not have to be notarized.
Hospital, clinic, doctor, nursing facility, skilled care facility or other medical institution records showing US birthplace
Life, health, or other insurance records indicating US place of birth
Official religious document, recorded in US, showing US birthplace
Pre-school, school, Head Start or daycare records with child’s name and US birthplace
Federal or state census record showing US citizenship or US birthplace
If you cannot get a citizenship document listed in Column A above, you may submit an affidavit to prove your citizenship. It must be signed, under penalty of perjury, by another person who can attest to your citizenship. The affidavit must contain your name, date of birth and US birthplace. It does not have to be notarized.
IF YOU ARE UNABLE TO GET ANY OF THE DOCUMENTS ABOVE TO PROVE YOUR CITIZENSHIP, WE MAY BE ABLE TO HELP YOU.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

No New HEIGHTS system changes were needed to implement this policy. The DFA Form 800CITZ is primarily enclosed with the New HEIGHTS-generated DX0011, Citizenship Verification Request, in the mail job PNCN74DD, and neither the DX0011 nor the mail job required changes.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Form 800CITZ was updated to reflect the policy released in this SR. See the chart above in the POLICY section of this SR for the updated list of acceptable proofs of citizenship and identity. Since there are no changes associated with the use of this form, the instructions did not require revisions and will not be re-released with this SR.

The old version of DFA Form 800CITZ must be recycled and the new version used as of 1/1/14. Although a Certificate of Destruction has been included with the SR, an initial supply of the new version of the form will not be sent to the District Offices because the form is rarely used in the offices. The form is enclosed with the New HEIGHTS-generated DX0011, Citizenship Verification Request, in the mail job PNCN74DD, so is primarily used by the mail room who did get an initial supply of the new version of the form. However, DFA Form 800CITZ is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the Quarterly Forms Order (QFO). The form is also available electronically, for Department staff only, on the Lotus Notes Family Services Database.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual (FAM) Topics

Section 301.07 Verification of Identity

Section 305.05 Verification of Citizenship

Revised Adult Assistance Manual (AAM) Topics

Section 305.05 Verification of Citizenship and Identity

Revised Medical Assistance Manual (MAM) Topics

Section 227.03 Family Planning MA Application Process

Section 303.05 Verification of Citizenship and Identity

IMPLEMENTATION

The policy released in this SR is effective January 1, 2014.

All old versions of DFA Form 800CITZ must be recycled and the new version used as of 1/1/14. A Certificate of Destruction has been included with this SR. The form is available in the DHHS Warehouse and can be ordered using current forms reordering procedures, via the QFO. The form is also available electronically, for Department staff only, on the Lotus Notes Family Services Database.

CLIENT NOTIFICATION

Notification of the changes in the citizenship and identity verification requirements will be published in the NH Rulemaking Register, Office of Legislative Services, in early winter of 2014. A public hearing on the amended Administrative Rules will be held in late winter of 2014. No other client notification is planned.

TRAINING

No special training is planned.

FORMS MANUAL POSTING INSTRUCTIONS

Remove and Destroy

Insert

Forms Manual

DFA Form 800CITZ, Citizenship & ID Acceptable Proofs

DFA SR 10-31/August, 2010

1 back-to-back sheet

DFA Form 800CITZ, Citizenship & ID Acceptable Proofs

DFA SR 14-03/January, 2014

1 back-to-back sheet

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at www.dhhs.nh.gov/DFA/publications.htm, effective February 3, 2014. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Family Assistance, Adult Assistance, Medical Assistance, and Forms Manuals.

DFA/KD:s

CERTIFICATE OF DESTRUCTION
I certify that all copies of DFA Form 800CITZ, dated 08/10, SR 10/31, have been destroyed.
District Office Manager of Operations:
District Office:

Return this certificate to the DFA Policy Unit, 129 Pleasant St, Brown Bldg, 3rd Floor, Concord, NH 03301, after the instructions in the SR have been carried out.