Proof of Citizenship or U.S. National Status

Submit a copy of one of the following documents.
 

Primary (Stand-Alone) Evidence of Citizenship

1. U.S. Passport or U.S. Passport Card, current or expired (issued without limitation).
2. Certificate of U.S. Citizenship.
   • Form N-560.
   • Form N-561.
3. Certificate of Naturalization.
   • Forms N-550, N-570.
4. Documentary evidence issued by a federally recognized American Indian or Alaska Native tribe. Documents must identify the individual by name and confirm the individual’s membership, enrollment, or affiliation with a tribe. Documents include but are not limited to:
   • Tribal enrollment card.
   • Certificate of Degree of Indian Blood.
   • Tribal census document.
   • Documents on Tribal letterhead, issued under the signature of the appropriate Tribal official.

Secondary evidence of citizenship

If you do not have any of the above primary (standalone) evidence, provide copies of two documents (secondary evidence): one from List A and one from List B.

    List A

1. U.S. Public Birth Certificate.
2. Consular Report or Certificate of Child Born Abroad.
   • Department of State Form FS-545.
   • Department of State Form FS-240.
   • Department of State Form DS-1350.
3. Individual Fee Register receipt (INS Form G-711).
4. U.S. citizen identification card (I-197 or the prior version I-179).
5. Federal or State census record showing U.S. citizenship or U.S. place of birth.
6. A Northern Mariana Identification Card issued to a collectively naturalized citizen, who was born in the CNMI before Nov. 4, 1986 (I-873).
7. Adoption Decree.
   • A final adoption decree showing the child’s name and U.S. place of birth; or
   • If the adoption is not finalized, a statement from a state-approved adoption agency that shows the child’s name, U.S. place of birth, and birthdate or age (the adoption agency must state in the certification that the source of the place of birth information is an original birth certificate).
8. Documentation of a foreign-born child (including a foreign-born adopted child) who received automatic U.S. citizenship through (IR3 or IH3) or the Child Citizenship Act. Documentation must clearly show the child’s name and date of birth.
9. U.S. military records showing a U.S. place of birth.
10. Evidence of U.S. Civil Service employment before June 1, 1976.
11. U.S. medical records, including but not limited to hospital, clinic, midwife, or physician records or admission papers from a nursing facility, skilled care facility, or other institution.Records must:
    • Indicate U.S. place of birth.
    • Be signed and on hospital letterhead.
    • Be established at the time of the person's birth.
12. U.S. insurance records showing a U.S. place of birth.Records must:
    • Indicate U.S. place of birth.
    • Be created at least five years before the initial Covered California application date, unless the applicant is under the age of five.
13. Official religious records recorded in the U.S.Records must:
    • Be created within three months of birth.
    • Indicate U.S. place of birth.
    • Indicate the date of the birth or the individual's age at the time the record was made.
    • Be an official record recorded with the religious organization.
14. School records including pre-school, Head Start, and daycare records.Records must:
    • Indicate the child’s name.

    List B

1. Driver's license issued by a State or Territory, or ID card issued by the federal, state, or local government.
2. School identification card.
3. U.S. military card or draft record or Military dependent’s identification card.
4. U.S. Coast Guard Merchant Mariner card.
5. A clinic, doctor, hospital, or school record, including preschool or day care records (for children under 19 years old).
6. Two documents containing consistent information that proves the applicant’s identity, such as:
   • Birth Certificate.
   • Social Security card.
   • Marriage Certificate.
   • Divorce Decree.
   • Employer identification card.
   • High School or College Diploma (including high school equivalency diplomas).
   • Property deed or title document.