Category 5: Documentation WMS Federal Social Security Undocumented ACI Financial Number (SSN) Code Participat Requirement Aliens Category ion (FFP) Undocumented Aliens: Undocumented aliens are unable to E YES NOT (Undocumented aliens do provide documentation of immigration not have the permission of status, therefore, absent any Only eligible Required the USCIS to remain in the documentation they are eligible only for for the U.S. They may have entered the treatment of an emergency medical treatment of an the United States legally but condition. emergency have violated the terms of Undocumented children may be eligible medical their status, e.g. over-stayed condition a visa, or they may have for CHPlus. Undocumented pregnant entered without documents.) women continue to be eligible for PCAP. Most Common U. S. Citizenship and Immigration Services (USCIS) Documents (Forms) I-94 Arrival Departure Record/Card DD-Form 2 Military Identification Card I-181 Memorandum of Creation of Record of Lawful Permanent DD-214 Report of Separation Military Discharge Document Residence N-560 Certificate of Citizenship I-210 Voluntary Departure N-561 Certificate of Citizenship Replacement I-220B Order of Supervision N-560 Certificate of Citizenship I-130 Petition for Alien Relative N-561 Certificate of Citizenship Replacement I-140 Immigrant Petition for Alien Worker N-550 Certificate of Naturalization I-327 Permit to Reenter the United States I-360 Petition for Amerasian, Widow(er), or Special Immigrant N-570 Certificate of Naturalization Replacement (VAWA) Self-Petitioner I-197 United States Citizenship Identification Card (no longer I-551 Permanent Resident Card, Resident Alien Card or “green issued, but still acceptable) card” I-571 Refugee Travel Document I-179 United States Citizenship Identification Card (no I-688 Temporary Resident Card longer issued, but still acceptable) I-688B Employment Authorization Card I-766 Employment Authorization Document I-797 Notice of Action* * An I-797 Notice of Action is a receipt proving an applicant has submitted a benefit request. The I-797 alone may not indicate an immigration status. It is important to refer to the different immigration categories in this reference guide to see what documents must accompany the I-797, if any, for a specific category. Failure to do so may assign federal financial participation inappropriately. 1 Satisfactory immigration status is an immigration status that makes the individual eligible for benefits under the applicable program, if they meet the other eligibility requirements of the program. 2 The United States Citizenship and Immigration Services (USCIS) was formerly the Immigration and Naturalization Services (INS) and the Bureau of Citizenship and Immigration Services (BCIS). PLEASE NOTE: The relevant DATE for ELIGIBILITY is the DATE OF STATUS (DOS). This is the DATE QUALIFIED STATUS WAS GRANTED. The DATE ENTERED THE COUNTRY (DEC) is the day the individual arrived in the country. The DEC is optional or “O” PRUCOL category immigrants, however, if it can be obtained, it can be data entered. REVISED 11/23/18 Page 12 .