223.01 Verification: CM and Expanded CM SR 14-04 Dated 01/14

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The individual who signs DFA Form 800, Application for Assistance, Form 800HR, HEIGHTS-generated Application for Assistance, or DFA Form 800MA*, Application For Health Coverage & Help Paying Costs, on behalf of the child, must provide verification of all eligibility criteria.

. Require verification of the child's:

- residency. Self-attestation accepted with no further proof required;

- date of birth. Proof required only if there is a discrepancy during the electronic data crossmatch process;

- enumeration (SSN) status. Proof required only if there is a discrepancy during the electronic data crossmatch process;

- citizenship/immigration status. Proof required only if there is a discrepancy during the electronic data crossmatch process;

 *

- family income and MAGI income deductions. Proof required for income if there is a discrepancy during the electronic data crossmatch process. Proof required for MAGI income deductions.

 *

References: He-W 641.07, RSA 167:68,I, 42 CFR 435.117 - 42 CFR 435.118, Section 1902(l) of the SSA [42 U.S.C. 1396a], Section 2101 of the SSA [42 U.S.C. 1397aa]