Primary Evidence of U.S. Citizenship
The items listed below establish both U.S. citizenship and identity:
- Certificate of Naturalization (N-550 or N-570);
- Certificate of Citizenship (N-560 or N-561);
- U.S. Passport issued to a person born in one of the 50 U.S. states (NOTE: a passport that has expired is acceptable);
- U.S. Passport issued to a person born in Puerto Rico (NOTE: only an unexpired passport is acceptable);
- Active DCFS category 98 case screen print from ACID pages 1 and 3; active DCFS cases in offices 211, 611, 612, 613, 711, and 713 are acceptable; or
- A document issued by a federally recognized Indian Tribe (see WAG 25-05-06) evidencing membership, enrollment in, or affiliation with such Tribe. The document must identify the Federally recognized Indian Tribe which issued it, identify the individual by name, and confirm the individual's membership, enrollment in, or affiliation with that Tribe. Examples include (but are not limited to):
- Tribal enrollment and membership card;
- Certificate of degree of Indian blood issued by the Bureau of Indian Affairs;
- Tribal census document;
- Document issued by a Tribe indicating an individual's affiliation with the Tribe.
- Social Security Administration (SSA) inquiry response verifying citizenship and identity (see PM 22-14-03-e Citizenship Inquiry).
- Documentation that the person's mother was covered by HFS Medical benefits for the person's birth and the person was born on or after July 1, 2006 (citizenship and identity is deemed to be verified).
- Note: Document in the case write up how you determined that the child is a deemed newborn for citizenship and identity documentation purposes. In ACM use Item 74 code '51' when adding a "deemed newborn" to a case.
Persons who were not U. S. citizens at birth (born outside of the United States) must present primary evidence to document their citizenship and identity. Secondary, third-level and fourth-level evidence may not be used for such persons.
Other persons claiming U. S. citizenship, who do not have the documents listed above, must provide two pieces of evidence to establish identity and citizenship.
Secondary Evidence of U.S. Citizenship
The following documents are acceptable to establish U.S. citizenship if primary evidence is not available. Identity must also be established using one of the documents listed in WAG 03-01-01-c. Photocopies provided by the client are not acceptable.
- Certified copy of a birth certificate from any of the following:
- One of the 50 states in the U.S. or the District of Columbia;
- Puerto Rico (if born on or after 01/13/41 and issued on or after 07/01/10 for all new medical requests made after 10/31/10*);
- Virgin Islands of the U.S. (if born on or after 01/17/17);
- American Samoa;
- Swain's Island;
- North Mariana Islands (if born after 11/04/86);
- An amended birth certificate if it was amended before the child reached age 5;
NOTE: If the birth record was amended after the individual reached age 5, refer to Fourth-Level Evidence of U.S. Citizenship.
- Inactive DCFS category 98 case screen print from ACID pages 1 and 3. DCFS cases in offices 211, 611, 612, 613, 711, and 713 are acceptable;
- Final adoption decree showing a U.S. place of birth;
- KIDS IDPH Inquiry Screen print showing the person's name and city of birth;
- Certificate of Report of Birth (DS-1350);
- Consular Report/Certification of Birth Abroad of a U.S. citizen (FS-240 or FS 545) (children born in a foreign country to a U.S. citizen who was born in the U.S.);
- U.S. Citizen Identification Card (I-197 or I-179);
- Northern Mariana Card (I-873);
- Evidence of civil service employment by the U.S. government prior to June 1, 1976;
- Military records that list the person's city and state of birth;
- Results of central cross-matches with other agency databases; or
- For an adult's Illinois birth, Form 97 Verification of Birth, Marriage, Divorce or Death, verifying place of birth.
- For persons whose citizenship is established using Form 97 and an identity document, enter code 72 in Item 74.
- For persons whose citizenship is established using Form 97 and identity is not yet established, enter code 65 in Item 74
- Send Form 97
- to the local county clerk, or
- IDPH Division of Vital Records
925 E. Ridgely Ave., Springfield, IL 62702
- For out of state births, contact the appropriate state agency. A listing of appropriate agencies can be found at http://www.cdc.gov/nchs/w2w.htm. Follow the instructions provided by the state. If they charge a fee, contact the state agency and ask them to waive it. If they will not waive the fee, contact DHS.PolicyDevelopment@illinois.gov.
*Puerto Rico invalidated birth certificates issued prior to 07/01/10. If an applicant requested medical benefits after 10/31/10 and had not previously established U.S. citizenship using a Puerto Rican birth certificate, the applicant must submit a birth certificate issued on or after 07/01/10 to establish U.S. citizenship or provide other documents as described in WAG 03-01-01-b. If U.S. citizenship was established prior to 10/31/10 for a recipient using a Puerto Rican birth certificate (regardless of issue date) no further verification is needed.
Third-Level Evidence of U.S. Citizenship
The following documents are acceptable to establish U.S. citizenship if primary or secondary evidence is not available. Identity must also be established using a document listed in WAG 03-01-01-c.
- Extract of hospital record on hospital letterhead created at least 5 years before the date of application for medical benefits and showing a place of birth in the United States.
For children younger than 16, the hospital record extract must have been created within 12 months from the child's birth if it was not created at least 5 years prior to the date of application. Contact HFS Bureau of Medical Eligibility & Special Programs at 217-557-7158 if questions about the timeliness of the extract arise.
NOTE: the souvenir hospital certificate of birth is not an acceptable document.
- Life, health, or other insurance record showing a U.S. place of birth, that was created at least 5 years before the date of application for medical benefits.
Fourth-Level of Evidence of U.S. Citizenship
The following documents are acceptable to establish U.S. citizenship if primary, secondary, or third level evidence is not available. Identity must also be established using a document listed in WAG 03-01-01-c.
- Federal or State census record for persons born 1900 through 1950 showing the person's age and U.S. citizenship or U.S. place of birth;
- U.S. State Vital Statistics official notification of birth registration created at least 5 years* before the date of application for medical benefits;
- Certified copy of a birth certificate amended after the individual reached age 5 if it was amended at least 5 years* before the date of application for medical benefits;
- Institutional admit papers from another state that show place of birth and were created 5 years before the date of application for medical benefits;
NOTE: For group care residents, federal guidance allows the use of institutional admit papers if they show place of birth and the document was created at least 5 years before the date of application. Form 1156 Long Term Care Facility Notification with a revision date of 11-09 is valid to establish place of birth. Persons transferred into an Illinois facility from another state may have such documentation available.
- Statement signed by the physician or midwife who was present for the delivery of the U.S. citizen;
- Medical record (clinic, doctor, or hospital but not including immunization records) that indicates a U.S. place of birth and was created at least 5 years* before the date of application for medical benefits; or as a last resort,
- A written affidavit completed and signed by two persons who have personal knowledge of the U.S. citizen including one who is not related to the U.S. citizen. The signers must provide documents showing their own citizenship and identity.
*For children under age 16, the document must have been created within 12 months from the child's birth if it was not created at least 5 years prior to the date of application. Contact HFS Bureau of Medical Eligibility & Special Programs at 217-557-7158 if questions about the timeliness of the document arise.
Good Faith Effort
A determination of good faith effort must be documented in the case record. Document in the case notes that Form 3859B was provided. Include in the write-up the reason the person cannot provide the documentation and state that the person is making a good faith effort to try to get the documentation. Include the phrase "good faith effort" in the write-up.
Provide Form 3859B, Statement of Good Faith Effort, to clients who report that they are making a good faith effort to obtain the required documents. Do not take a negative action when a person is determined be making a good faith effort. Do not use Item 74 code '47' for persons who are making a good faith effort.
The client is expected to continue to make a good faith effort to get the citizenship and identity documentation.
Request the required documents at REDE/renewal. If the documents are not provided at REDE/renewal, determine whether the client is continuing to make a good faith effort. Take the appropriate negative action if good faith effort policy no longer applies.