The following are accepted as primary-level documentation of citizenship or nationality and identity. All of these documents have a photograph of the individual named in the document.
U.S. passport.
A certificate of naturalization (Department of Homeland Security Forms N-550 or N-570).
NOTE: A Memorandum of Understanding between the Department of Homeland Security (DHS) and the Department of Human Services has been revised to grant permission to verify the status of naturalized citizens through Systematic Alien Verification for Entitlements (SAVE). The CAO will need the alien registration number (A#) of the naturalized citizen to verify the individual’s status. However, Form G-845S, Document Verification Request, cannot be used as proof of U.S. citizenship. The individual must cooperate in getting a copy of the naturalization certificate or in submitting other proof of U.S. citizenship along with identity papers. Once the individual has confirmation of naturalized citizenship status through SAVE, the individual will be approved for MA if he or she is eligible in all other ways. (See Supplemental Handbook Chapter 740, SAVE Procedures.)
A certificate of United States citizenship (DHS Forms N-560 or N-561).
NOTE: If an individual does not have any of the above, the individual must provide proof of citizenship or nationality and proof of identity.
The following are accepted as Secondary- Level Documentation of Citizenship (but not Identity):
A U.S. birth certificate from one of the fifty states or the District of Columbia.
The applicant or recipient must present an original document to be photocopied. A photocopy of the birth certificate should be kept in the case record.
A certification of birth (Form DS-1350) issued by the Department of Homeland Security (DHS).
A report of birth abroad of a citizen of the U.S. (Form FS-240).
A certification of birth abroad (Form FS-545).
NOTE: For a Certification of Birth (Form FS-545 or DS-1350) or replacement of a Consular Report of Birth (Form FS-240) write to:
U.S. Department of State
Vital Records Section
Passport Services
1111 19th Street, NW, Suite 510
Washington, DC 20522-1705
A written request must be notarized and include a copy of valid photo identification of the requester. The written request must include the following:
Full name of the child at birth (plus any adoptive names).
Date and place of birth.
Names of the parents.
Serial number, if known, of the FS-240 (on those issued after November 1, 1990).
Any available passport information.
Signature of the requester.
Notarized affidavit for a replacement FS-240 (if applicable).
A U.S. citizen identification card (DHS Form I-197 or I-179).
Neither card is currently issued, but either form that was issued in the past is still valid.
An American Indian Card (I-872) issued by the DHS with the classification code “KIC.”
This card is issued by the DHS to identify U.S. citizen members of the Texas Band of Kickapoos living near the U.S./Mexican border.
A Northern Mariana Identification Card (I-873).
This card was issued by the DHS to collectively naturalized citizens of the U.S. who were born in the Northern Mariana Islands before November 4, 1986. This card is no longer issued, but those that were issued in the past are still valid.
A final adoption decree.
The adoption decree must show the child’s name and U.S. place of birth. In situations where an adoption is not finalized and the state in which the child was born will not release a birth certificate before the final adoption, a statement from a state-approved adoption agency that shows the child’s name and U.S. place of birth is acceptable. The adoption agency must state in the certification that the source of the place-of-birth information is an original birth certificate.
Proof of Civil Service employment by the U.S. government before June 1976.
An official military record of service showing a U.S. place of birth (DD-214 or a similar official document).
Proof of meeting the automatic criteria for U.S. citizenship outlined in the Child Citizenship Act of 2000 for a biological or adopted child born outside the United States.
The following are accepted as third-level documentation of citizenship (Not Identity):
Part of a hospital record of birth on hospital letterhead established when the individual was born and showing a U.S. place of birth and created at least five years before the MA application date.
NOTE: For children under 16, the document must have been created near the time of birth or five years before the date of application. Do not accept souvenir birth certificates issued by the hospital.
Religious record recorded in the U.S. within three months of birth showing the birth took place in the U.S. and showing either the date of the birth or the individual’s age at the time the record was made.
The record must be an official record recorded with the religious organization, such as a baptismal certificate.
Caution: In questionable cases (for example, where the child’s religious record was recorded near a U.S. international border and the child may have been born outside the U.S.), the state must verify the religious record or document that the mother was in the U.S. at the time of birth.
Entries in a family Bible are not considered religious records.
An early school record showing a U.S. place of birth.
The school record must show the name of the child, the date of admission to the school, the date of birth, a U.S. place of birth, and the names and places of birth of the applicant’s parents.
Applicants or recipients over 65 years of age may have this type of early school record showing a U.S. place of birth along with the parents’ information.
A life, health, or other insurance record showing a U.S. place of birth created at least five years before the MA application (or near the time of birth for children under age 16).
The following are accepted as fourth-level documentation of citizenship (Not Identity):
NOTE: Fourth-level evidence of citizenship is documentary evidence that is the least reliable type of proof. Fourth-level evidence should be used only rarely (when no other higher-level documents are available).
A federal or state census record showing U.S. citizenship or a U.S. place of birth (generally for individuals born 1900–1950).
A Seneca Indian tribal census record showing U.S. citizenship or a U.S. place of birth and created at least five years before the MA application date (or near the time of birth for children under age 16).
A Bureau of Indian Affairs tribal census record of the Navajo Indians that was created at least five years before the MA application date (or near the time of birth for children under age 16).
The Bureau of Indian Affairs Roll of Alaska Natives created at least five years before the MA application date (or near the time of birth for children under age 16).
A U.S. state vital statistics official notification of birth registration that was created at least five years before the MA application date (or near the time of birth for children under age 16).
A delayed (changed) U.S. public birth record that was recorded more than five years after the individual’s date of birth and was created at least five years before the MA application date (or near the time of birth for children under age 16).
A statement signed by the physician or midwife who was there when the individual was born that was created at least five years before the MA application date (or near the time of birth for children under age 16).
Institutional admission papers from a nursing home, skilled nursing facility, or other institution showing a U.S. place of birth that was created at least five years before the MA application date.
Medical (clinic, doctor, or hospital) record that indicates a U.S. place of birth that was created at least five years before the MA application date (or near the time of birth for children under age 5).
NOTE: An immunization record is not considered a medical record for the purposes of establishing U.S. citizenship.
Affidavits (written statements made under oath) may be used only when the state cannot get other proof of citizenship.
When affidavits are used as proof of citizenship, the following rules apply:
There must be at least two affidavits by two individuals who know about the events named in the applicant or recipient’s claim of citizenship. The two affidavits could be combined in a joint affidavit.
At least one of the individuals making the affidavit cannot be related to the applicant or recipient and cannot be the applicant or recipient.
The individuals making the affidavits must be able to show proof of their own citizenship and identity.
If the individuals making the affidavits have information that explains why documentary proof of the applicant or recipient’s claim of citizenship does not exist or is not easy to get, the affidavit should have this information too.
A separate affidavit must be obtained from the applicant or recipient or other knowledgeable individual (guardian or representative) explaining why the proof does not exist or cannot be gotten.
The affidavits must be signed under penalty of perjury.
NOTE: Naturalized citizens are permitted to use the affidavit process.
NOTE: An individual may not use affidavits as documentation of both citizenship and identity. The individual must choose one or the other.
The following documents are accepted as primary-level documentation of nationality (Not Identity):
Puerto Rico: (a) Proof of birth in Puerto Rico on or after April 11, 1899, and the applicant or recipient’s statement that he or she was living in the U.S., a U.S. possession, or Puerto Rico on January 13, 1941; or (b) proof that the applicant or recipient was a Puerto Rican citizen and the applicant or recipient’s statement that he or she was living in Puerto Rico on March 1, 1917, and that he or she did not take an oath of allegiance to Spain.
U.S. Virgin Islands: (a) Proof of birth in the U.S. Virgin Islands and the applicant or recipient’s statement that he or she was living in the U.S., a U.S. possession, or the U.S. Virgin Islands on February 25, 1927; (b) the applicant or recipient’s statement that he or she was living in the U.S. Virgin Islands as a Danish citizen on January 17, 1917, and in the U.S., a U.S. possession, or the U.S. Virgin Islands on February 25, 1927, and that he or she did not make a declaration to maintain Danish citizenship; or (c) proof of birth in the U.S. Virgin Islands and the applicant or recipient’s statement that he or she lived in the U.S., a U.S. possession or territory, or the Canal Zone on June 28, 1932.
Northern Mariana Islands (NMI), formerly part of the Trust Territory of the Pacific Islands (TTPI): (a) Proof of birth in the NMI, TTPI citizenship and residence in the NMI, the U.S., or a U.S. territory or possession on November 3, 1986, NMI local time) and the applicant or recipient’s statement that he or she did not owe allegiance to a foreign State on November 4, 1986 (NMI local time); (b) proof of TTPI citizenship, continuous residence in the NMI since before November 3, 1981 (NMI local time), voter registration before January 1, 1975, and the applicant or recipient’s statement that he or she did not owe allegiance to a foreign State on November 4, 1986 (NMI local time); or (c) proof of continuous living in the NMI since before January 1, 1974, and the applicant or recipient’s statement that he or she did not owe allegiance to a foreign State on November 4, 1986 (NMI local time).
Guam: Proof of birth in Guam on or after April 10, 1899.
Swain’s Island and American Samoa: Proof of birth in Swain’s Island or American Samoa. Individuals born in American Samoa and Swain’s Island are generally U.S. noncitizen nationals.
The following are documents that are acceptable as secondary-level documentation of identity:
NOTE: These documents cannot be used as proof of citizenship or nationality.
NOTE: States may accept identity documents that have recently expired as long as there is no reason to believe that the document does not match the individual.
A Pennsylvania or out-of-state driver’s license with the individual’s picture or having other identifying information, such as name, age, sex, race, height, weight, or eye color (does not need to be current)
NOTE: Do not accept a Canadian driver’s license.
A Pennsylvania or out-of-state identity card issued to a nondriver with the individual’s picture or having other identifying information, such as name, age, sex, race, height, weight or eye color (does not need to be current)
NOTE: Do not accept a voter’s registration card.
A U.S. military identification or draft record (active duty, dependent, retired, reserves, or National Guard).
A U.S. Coast Guard Merchant Mariner card.
An identification card issued by the Federal, State, or local government having the individual’s picture or other identifying information such as name, age, sex, race, height, weight or eye color.
Military dependents identification card.
Certificate of Degree of Indian Blood or other U.S. American Indian/Alaska Native tribal document having the individual’s picture or other identifying information such as name, age, sex, race, height, weight or eye color.
Three or more documents such as marriage licenses, divorce decrees, high school and college diplomas from accredited institutions (including general education and high school equivalency diplomas), property deeds or titles, and employer ID cards used to prove an individual’s identity.
NOTE: These documents can only be used as proof of identity if they have not been used to establish the individual’s citizenship, and the applicant submitted secondary-level or third-level citizenship documentation—not fourth-level documentation. (See Section 322.21, Primary Level Proof of Citizenship.)
NOTE: A combination of three or more of these documents must show the same evidence and must not conflict with each other. The documents must be originals or certified copies.
For children under 16, a school record including a report card or daycare or nursery school record, verified by the issuing school.
A school (primary, secondary, or higher level) or educational institute identification card with the individual’s picture.
For children under age 16, a clinic, doctor or hospital record.
A properly executed acknowledgement of paternity form (PA/CS 611).
NOTE: The actual form must be in the case record. The Bureau of Child Support Enforcement (BCSE) will provide a certified copy of the PA/CS 611 with a written request, a fax request, or a telephone call from the CAO. The CAO should try to get other forms of ID before using the acknowledgement of paternity form.
Data matches with the Department of Health or the Department of Transportation (Penn Dot).
NOTE: Currently these are the only two acceptable data matches with other agencies. PACSES is not an acceptable data match.
NOTE: Social Security cards and MA 112s received from hospitals are not acceptable proof of identity for MA.
Affidavits (written statements made under oath) can be used as acceptable proof of identity only if the individual was unable to show primary-level or secondary-level proof.
When affidavits are used as proof of identity, the following rules apply:
A disabled individual in a residential care facility may have his or her identity confirmed by the facility director or administrator when the individual does not have or cannot get any of the documents listed above. Again, the affidavit is signed under penalty of perjury, but it does not need to be notarized. The definition of disability will be determined on by the facility.
An affidavit of identity can be used for children under age 16.
Exception: Identity affidavits may occasionally be used for children age 16–18 when they cannot get school ID cards or driver’s licenses before the age of 18.
When an affidavit is used as proof of citizenship, another affidavit cannot be used as proof of identity.
The affidavit must be signed under penalty of perjury by a parent, guardian, or caretaker relative.
NOTE: The affidavit may be signed by a parent who is an illegal alien. The CAO will ask for proof of identity for the illegal parent. If the parent cannot provide it, the affidavit will still be accepted.
NOTE: If the parent, guardian, or caretaker relative is unwilling or unable to sign the affidavit, a representative of the county may sign the affidavit when legal custody has been transferred to the Children and Youth Agency or when the child is court-ordered to placement through the Juvenile Probation Office.
NOTE: The caseworker may witness the affidavit at a face-to-face interview but will not act as a witness for a mailed-in affidavit.
The affidavit does not need to be notarized.
Updated May 27, 2016, Replacing February 14, 2012