305.03 Declaration of Citizenship SR 99-03, 02/99 (FAM-A)

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Each household applying for assistance must declare on Form 800H,, HEIGHTS Application Form, paper Form 800, Application, or 800P, Application For New Hampshire Healthy Kids Medical Insurance and Medical Coverage for Pregnant Women , the citizenship or noncitizen status of each household member applying for assistance.

• If there is no adult member in the assistance group, the child applying may sign for all members.

• An authorized representative may sign for an individual with a severe physical or mental disability who cannot provide a signature. If the individual signs an "x," the mark must be witnessed.