Section 504.005 - Documents for Verifying U.S. Citizenship and Identity and Immigration Status(A)Acceptable Proof of U.S. Citizenship and Identity. Pursuant to 130 CMR 504.004(B), U.S. citizens must provide proof of both citizenship and identity. (1)Acceptable Proof of Both Citizenship and Identity. The following documents are satisfactory proof of both citizenship and identity:(a) U.S. passport, including a U.S. Passport Card issued by the Department of State, without regard to any expiration date as long as such passport or Card was issued without limitation;(b) Certificate of Naturalization;(c) Certificate of U.S. Citizenship; or(d) a document issued by a federally recognized Indian tribe, as published in the Federal Register by the Bureau of Indian Affairs within the U.S. Department of the Interior, and identifies the federally recognized Indian tribe that issued the document, identifies the individual by name, and confirms the individual's membership, enrollment, or affiliation with the tribe. These documents include, but are not limited to, a tribal enrollment card, a Certificate of Degree of Indian Blood, a tribal census document, and documents on tribal letterhead, issued under the signature of the appropriate tribal official that meet the requirements of 130 CMR 504.005(A)(1)(d).(2)Acceptable Proof of Citizenship. If one of the documents listed in 130 CMR 504.005(A)(1) is not provided, the following documents are acceptable as satisfactory evidence to establish citizenship if also accompanied by an identity document listed in 130 CMR 504.005(A)(3): (a) U.S. public birth certificate showing birth in one of the 50 states (including the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam, the U.S. Virgin Islands (if born on or after January 17, 1917), American Samoa, Swain's Island, or the Commonwealth of the Northern Mariana Islands (CNMI) (if born after November 4, 1986, CNMI local time). The birth record may be issued by the state, commonwealth, territory, or local jurisdiction. However, if the document shows the individual was born in Puerto Rico, the U.S. Virgin Islands, or the CNMI before these areas became part of the U.S., the individual may be a collectively naturalized citizen;(b) cross-match with the Massachusetts Registry of Vital Statistics that documents a record of birth;(c) Certification of Report of Birth, issued to U.S. citizens who were born outside the U.S.;(d) Report of Birth Abroad of a U.S. Citizen;(e) certification of birth;(f) U.S. Citizen I.D. card;(g) Northern Mariana Identification Card, issued to a collectively naturalized citizen who was born in the CNMI before November 4, 1986;(h) final adoption decree showing the child's name and U.S. place of birth, or, if the adoption is not final, a statement from state-approved adoption agency that shows the child's name and U.S. place of birth;(i) evidence of U.S. civil service employment prior to June 1, 1976;(j) U.S. military record showing a U.S. place of birth;(k) data match with the Systematic Alien Verification for Entitlements (SAVE) Program or any other process established by the U.S. Department of Homeland Security to verify that an individual is a citizen;(l) documentation that the child meets the requirements of § 101of the Child Citizenship Act of 2000 (8 U.S.C. 1431);(m) medical records including, but not limited to, hospital, clinic, or doctor records or admission papers from a nursing facility, skilled-care facility, or other institution that indicate place of birth;(n) life, health, or other insurance records that indicate a U.S. place of birth;(o) official religious records recorded in the U.S. showing that the birth occurred in the U.S.;(p) school records, including preschool, Head Start, and day care, showing the child's name and U.S. place of birth;(q) federal or state census records showing U.S. citizenship or a U.S. place of birth; and (r) if an individual does not have one of the documents listed in 130 CMR 504.005(A)(2)(a) through (q), he or she may submit an affidavit signed by another individual, under penalty of perjury, who can reasonably attest to the individual's citizenship, and that contains the individual's name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized.(3)Acceptable Proof of Identity. The following are considered acceptable proof of identity. (a) the following are acceptable proof of identity, provided such documentation has a photograph or other identifying information including, but not limited to, name, age, sex, race, height, weight, eye color, or address: 1. identity documents listed at 8 CFR 274a.2(b)(1)(v)(B)(1), except a driver's license issued by a Canadian government authority;2. driver's license issued by a state or territory;3. school identification card;4. U.S. military card or draft record;5. identification card issued by the federal, state, or local government;6. military dependent's identification card; or7. U.S. Coast Guard Merchant Mariner card;(b) for children younger than 19 years old, a clinic, doctor, hospital, or school record, including preschool or day care records;(c) two documents containing consistent information that corroborates an applicant's identity. Such documents include, but are not limited to1. employer identification cards;2. high school and college diplomas (including high school equivalency diplomas);3. marriage certificates;5. property deeds or titles;6. a pay stub from a current employer with the applicant's name and address preprinted, dated within 60 days of the application;7. census verification containing the applicant's name and address, dated not more than 12 months before the date of the application;8. a pension or retirement statement from a prior employer or pension fund stating the applicant's name and address, dated within 12 months of the application;9. tuition or student loan bill containing the applicant's name and address, dated not more than 12 months before the date of the application;10. utility bill, cell phone bill, credit card bill, doctor's bill, or hospital bill containing applicant's name and address, dated not more than 60 days before the date of the application;11. valid homeowner's, renter's, or automobile insurance policy with preprinted address, dated not more than 12 months before the date of the application, or a bill for such insurance with preprinted address, dated not more than 60 days before the date of the application;12. lease dated not more than 12 months before the date of the application, or home mortgage identifying applicant and address; or13. employment verification by means of W-2 forms or other documents bearing the applicant's name and address submitted by the employer to a government agency as a consequence of employment.(d) a finding of identity from a federal or state agency including, but not limited to, a public assistance, law enforcement, internal revenue, or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual;(e) a finding of identity from an Express Lane agency, as defined in § 1902(e)(13)(F) of the Social Security Act; or(f) if the applicant does not have any document specified in 130 CMR 504.005(A)(3)(a) through (c) and identity is not verified under 130 CMR 504.005(A)(3)(d) or (e), the applicant may submit an affidavit signed, under penalty of perjury, by another person who can reasonably attest to the applicant's identity. Such affidavit must contain the applicant's name and other identifying information establishing identity, as described in 130 CMR 504.005(A)(3)(a). This affidavit does not have to be notarized.(4)Verification of Citizenship or Identity by a Federal Agency or Another State. The MassHealth agency may rely, without further documentation of citizenship or identity, on a verification of citizenship or identity made by a federal agency or another state, if such verification was done on or after July 1, 2006.(5)Assistance with Obtaining Documentation. The MassHealth agency will provide assistance to individuals who need assistance in securing satisfactory documentary evidence of citizenship in a timely manner.(B)Acceptable Proof of Immigration Status. Acceptable proof of immigration status includes any verification allowed under federal law as determined by the MassHealth agency.(C)Documentary Evidence. A photocopy, facsimile, scan, or other copy of a document will be accepted to the same extent as an original document, unless information on the submitted document is inconsistent with other information available to the MassHealth agency or the MassHealth agency otherwise has reason to question the validity of the document or the information on the document.Amended by Mass Register Issue 1476, eff. 8/19/2022.