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Documents needed to confirm your eligibility for a Qualified Health Plan (QHP)

The links below highlight the documents needed to support your application and confirm eligibility:

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Qualifying
Proof

Proof of U.S. Citizenship or U.S. National Status

To verify your U. S. citizenship or National Status, send us any of the following documents:

Citizenship

U.S. Passport or U.S. Passport Card, current or expired (issued without limitation).
Sample U.S. Birth Certificate can be viewed here.
Certification of Report of Birth.
  • Form N-560
  • Form N-561
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. Acceptable 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.
  • Department of State Form FS-545
  • Department of State Form FS-240
  • Department of State Form DS-1350

Citizenship 2

U.S. Citizen Identification Card (I-197 or the prior version I-179)
Federal or State census record showing U.S. citizenship or U.S. place of birth.
Northern Marianas Identification Card.
  • 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).
Documentation that a child meets the requirements of section 101 of the Child Citizenship Act of 2000 (8 U.S.C. 1431).
U.S. military records showing a U.S. place of birth.
Evidence of U.S. Civil Service employment before June 1, 1976.

All documents that you submit for verification of citizenship must match your name and birth date and, if applicable, the name and birth date of each member of your household included on the application.

How to Submit Documents

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Sample US Birth Certificate
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Sample Employer Statement SP
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Sample Attestation of Non Income Form SP
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Sample Affidavit of Identity Form Individual SP
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Sample Affidavit of Identity Form Child SP
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Sample W-2 SP
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Sample 2017 Schedule E SP
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Sample 2017 Schedule C SP
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Sample 1040 SP
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