Click on the arrow next to the document type below to see the list of acceptable documents that can be used to verify that specific document type
American Indian/Alaska Native (AI/AN) Status Verification
- Tribal Card
- Document issued by BIA recognizing an individual as American Indian/Alaska Native
- Authentic document from a tribe declaring membership for an individual
- Certificate of Degree of Indian Blood
- Certificate of Indian Status card
- I-872 American Indian Card
- Document issued by IHS indicating individual is/was eligible for IHS services as an American Indian/Alaska Native
- U.S. American Indian/Alaska Native tribal enrollment documentation
- Document that shows a relationship to an individual listed on an Indian Census Roll
Asset Verification
Annuity
- Contract showing owner's name, name of person getting income, company name, dates of purchase, purchase price, and amount of income received.
Bank Accounts
- Must verify the amount on deposit by bank books or bank statements that show the bank balance within 45 days of the date of application or eligibility review.
Burial Plan
- Prepaid and dated irrevocable contract or irrevocable trust signed by both you and the funeral home director, or;
- Itemized statement from the funeral home director to prove existence of an irrevocable burial contract, or irrevocable trust, an irrevocable trust instrument, any burial insurance policy, or any statement signed by you designating a burial account or life insurance policy for burial purposes.
Life insurance
- Copy of the first page of all life-insurance policies, including life insurance policies set up for burial only. If total face value of all policies exceeds $1,500, also send a letter from the insurance company showing the current cash-surrender value (for all policies except term policies).
Real Estate
- Copy of the deed(s) and current tax bill for all properties that you and/or your spouse have a legal interest in.
Stocks/Bonds/Other Securities
- Copy of certificates, current quote from stockbroker, daily paper, or investment firm to prove current value, copy of savings bonds, and financial statements showing activity during the last 36 months.
Tax Returns
- Copy of your U.S Federal Tax Return for the last two years for both you and your spouse.
Transferred Resources
- All documents that transfer assets or income, showing the date of transfer, value of the asset or income on date of transfer, and the name of person to whom transfer was made.
Vehicles/Mobile homes
- Titles or registrations to all vehicles and loan agreements; bill of sale for mobile homes.
Deposit to any Health-Care or Residential Facility
- Proof of all deposits made to the Health-Care or Residential Facility.
Guardianship Verification
- Court documents showing legal Guardianship.
Health Insurance Verification
- Copy of both sides of all health insurance cards and a copy of your current premium bill.
Immigration Status and Identity for Non-Citizens Verification
If you are not a U.S. citizen and we asked you to prove your immigration status you must send in proof. Proof may include, but is not limited to, the following items. Please make sure to include a copy of both sides of all immigration cards or other documents that show your status.
- Permanent Resident Card, "Green Card" (I-551)
- Reentry Permit (I-327)
- Refugee Travel Document (I-571)
- Machine Readable Immigrant Visa (with temporary I-551 language)
- Temporary I-551 Stamp (on Passport or I-94/I-94A)
- Foreign passport
- Arrival/Departure Record (I-94/I-94A)
- Arrival/Departure Record in foreign passport (I-94)
- Certificate of Eligibility for Nonimmigrant Student Status (I-20)
- Certificate of Eligibility for Exchange Visitor Status (DS-2019)
- Employment Authorization Card (I-766)
- Notice of Action (I-797)
- Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
- Document indicating withholding of removal (or withholding of deportation)
- Administrative order staying removal issued by the Department of Homeland Security
- Document indicating a member of a federally recognized Indian tribe or American Indian born in Canada
- Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
- Resident of American Samoa Card
Income Verification
Reminder: Gross income is your income from any source before deductions are taken out.
Earned Income
Proof of Job Income
Please send us one of the following showing gross pay and deductions and the number of hours worked per pay period:
- Recent pay stubs
- Your most recent Form 1040 (U.S. Individual Income Tax Return) with all attachments including W2s
- A signed statement from your employer
- If you are seasonally employed, any of the proofs above including information about the duration of your employment
- Military Leave and Earnings statement
- Agricultural income certificate
Proof of Self-Employment Income
- Your most recent Form 1040 (U.S. Individual Income Tax Return) with Schedule 1 for self-employment income and any applicable schedules (Schedule C, SE, F, J)
- 1099-MISC and your most recent Form 1040 (U.S. Individual Income Tax Return) with all attachments
- Self-employment ledger
- Bookkeeping records
- Signed and dated most recent quarterly or year-to-date profit and loss statement
Unearned Income
Please send us one of the following showing gross income from each income source:
- Copy of your check stub or award letter
- Statement from the company, agency, or other income source issuing the payment or benefit.
- Most recent Form 1040 (U.S. Individual Income Tax Return) with all attachments.
Rental Income
Please send us the following for all units:
- Proof of rental income and expenses for the past 12 months, including taxes, mortgage statement, insurance, heat and water if provided, and repairs and maintenance.
Proof of Other Income
Acceptable proof of "other" income (income not earned from a job) includes the following:
- Cost of living adjustment letter and other benefit verification notices
- Lease agreement
- Bank or investment fund statement
- Document or letter from Social Security Administration (SSA)
- Form SSA 1099 Social Security benefits statement
- Your most recent Form 1040 (U.S. Individual Income Tax Return) with Schedule 1 for Social Security Benefits
- Recent court records for alimony and records of agency through which alimony is paid as well as the names of the people who got divorced and the date the divorce agreement was executed or finalized
- Your most recent Form 1040 including proof of when the divorce agreement was executed or finalized
- Recent legal documents showing the amount and frequency of alimony payments, as well as the names of the people who got divorced and the date the divorce agreement was executed or finalized
- Your most recent Form 1040 (U.S. Individual Income Tax Return) with Schedule 1 for alimony, as well as documents showing the names of the people who got divorced and the date the divorce agreement was executed or finalized
- Letter from government agency for unemployment benefits
- Your most recent Form 1040 (U.S. Individual Income Tax Return) with Schedule 1 for unemployment benefits
- Proof of tribal income
- 1099-G and your most recent Form 1040 (U.S. Individual Income Tax Return) with all attachments
- Military Leave and Earnings statement
- Proof of gambling winnings
- Proof of total lump-sum lottery winnings or lottery winnings to be paid in installment
- Your most recent Form 1040 (U.S. Individual Income Tax Return) with Schedule 1 for gambling winnings
- Annuity statement
- Your most recent Form 1040 (U.S. Individual Income Tax Return) with Schedule 1 and Schedule D for capital gains and losses
- Statement of pension distribution from any government or private source
- Recent prizes, settlements, and awards, including court-ordered awards letter
- Proof of gifts and contributions
- Proof of inheritances in cash or property
- Proof of strike pay and other benefits from unions
- Sales receipts or other proof of money received from the sale, exchange or replacement of things you own
- Interests and dividends income statement
- Your most recent Form 1040 (U.S. Individual Income Tax Return) with Schedule B for interest and ordinary dividends
- Loan statement showing loan proceeds
- Royalty income statement or 1099-MISC and most recent Form 1040 (U.S. Individual Income Tax Return) with Schedule 1 and Schedule E
- Proof of bonus/incentive payments
- Proof of severance pay
- Pay stub indicating sick pay
- Letter, deposit, or other proof of deferred compensation payments
- Pay stub indicating substitute/assistant pay
- Pay stub indicating vacation pay
- Proof of residuals
- Letter, deposit, or other proof of travel/business reimbursement pay
Massachusetts Residency Verification
Acceptable proof of Massachusetts residency includes the following:
- Copy of deed and record of most recent mortgage payment (if mortgage is paid in full, provide a copy of property tax bill from the most recent year)
- Copy of lease and record of most recent rent payment
- Mortgage deed showing primary residence
- Nursery school or daycare records (if school is private, additional documentation may be requested)
- Current utility bill or work order dated within the past 60 days
- Statement from a homeless shelter
- School records (if school is private, additional documentation may be requested)
- Section 8 agreement
- Homeowner's insurance agreement
- Proof of enrollment of custodial dependent in public school
- If an individual does not have one of the documents listed above, he or she may submit an affidavit supporting residency signed under penalty of perjury. The affidavit does not have to be notarized. To get a copy of the Affidavit to Verify Massachusetts Residency you can also go to www.mass.gov/service-details/masshealth-member-forms
Social Security Number (SSN) Verification
Acceptable proof of Social Security Number includes the following:
- SSN Card
- Benefit or income statement from Social Security containing your SSN
- Pending application for an SSN
- Tax form(s)
Trust Verification
- All trust documents and accountings that show all assets in the trust including current balance and all activity during the latest period. Also send proof of all income distributed, a schedule of trust assets, and a schedule of beneficiaries. If a realty trust, send a copy of the deed(s) and current real estate tax bill or official property assessment from the city or town.
U.S. Citizenship Status Verification
You can use the following documents to satisfy proof of both citizenship and identity:
- U.S. passport, including a U.S. Passport Card issued by the Department of State, without regarding to any expiration date as long as such passport or Card was issued without limitation;
- a Certificate of Naturalization (DHS Form N-550 or N-570); or
- a Certificate of U.S. Citizenship (DHS Form N-560 or N-561); or
- a document issued by a federally recognized American Indian tribe showing membership or enrollment in, or affiliation with, such tribe.
If one of the documents listed above is not available, you may be able to verify your citizenship with one of the following documents if you send it with a document listed below that verifies identity.
- A U.S. public record of birth (including the 50 states, the District of Columbia, Puerto Rico (on or after January 13, 1941), Guam (on or after April 10, 1899), the U.S. Virgin Islands (on or after January 17, 1917), American Samoa, Swain's Island, or the Northern Mariana Islands (after November 4, 1986). The individual may also be collectively naturalized under federal regulations. The birth record must have been recorded within five years of birth.
- A Report of Birth Abroad of a U.S. Citizen (Form FS-545, Form FS-240, or Form DS-1350)
- A U.S. Citizen ID card (INS Form I-197 or I-179)
- An American Indian Card (I-872 with the classification code KIC) issued by the Department of Homeland Security (DHS) to identify U.S. citizen members of the Texas Band of Kickapoos living near the U.S./Mexican border
- Final adoption decree showing the child's name and U.S. place of birth (if adoption is not finalized, a statement from a state-approved adoption agency)
- Evidence of U.S. civil service employment before June 1, 1976
- An official military record showing a U.S. place of birth
- A Northern Mariana Identification Card (I-873) issued by the INS to a collectively naturalized citizen of the United States who was born in the Northern Mariana Islands before November 4, 1986
- Documentary evidence under the Child Citizenship Act for adopted children born outside the U.S.
- Extract of U.S. hospital record of birth on hospital letterhead established at the time of the person's birth that was created five years before the initial application date and that indicates a U.S. place of birth. For children under age 16, the hospital record must have been created near the time of birth or five years before the application date. A souvenir birth certificate is not acceptable.
- Life, health, or other insurance record showing a U.S. place of birth that was created at least 5 years before the initial application date that indicates a U.S. place of birth. For children under age 16, the document must have been created near the time of birth or five years before the application date.
- An official religious record recorded with the religious organization in the U.S. within three months of birth showing the birth occurred in the U.S. and showing either the date of birth or the individual's age at the time the record was made. Entries in a family bible are not considered religious records.
- An early school record showing the child's name, U.S. place of birth, date of admission, and date of birth
- Birth records recorded after the person turned age five
- Federal or state census record showing U.S. citizenship or a U.S. place of birth and person's age
- Admission papers from a nursing home, skilled-care facility, or other institution that were created at least five years before the initial application date and that indicate a U.S. place of birth
- Medical (clinic, doctor, or hospital) record indicating a U.S. place of birth that was created at least 5 years before the initial application date. For children under age 16, the medical record must have been created near the time of birth or five years before the application date.
- Other documents that show a U.S. place of birth that were created at least 5 years before the application for MassHealth (For children younger than age 16, the document must have been created near the time of birth or five years before the application date.): Seneca or Navajo Indian tribal census records, U.S. State Vital Statistics official notification of birth registration, an amended U.S. public birth record that was amended more than five years after the person's birth, a statement from a physician/midwife who was in attendance at the birth, or the Bureau of Indian Affairs Roll of Alaska Natives
- If an individual does not have one of the documents listed above, he or she may submit an affidavit signed by another individual, under penalty of perjury, who can reasonably attest to the individual's citizenship, and that contains the individual's name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized.
Identity Verification Only
- The following are acceptable proof of identity. It must have a photograph or other identifying
information, including name, age, sex assigned at birth, race, height, weight, eye color, or address.
- identity documents listed at 8 CFR 274a.2(b)(1)(v)(B)(1), except a driver's license issued by a Canadian government authority;
- driver's license issued by a state or territory;
- school identification card;
- U.S. military card or draft record;
- identification card issued by the federal, state, or local government;
- military dependent's identification card; or
- U.S. Coast Guard Merchant Mariner card;
- For children younger than age 19, a clinic, doctor, hospital, or school record, including preschool or day care records;
- Two documents containing consistent information that corroborates an applicant's identity. Such
documents include, but are not limited to:
- employer identification cards;
- high school and college diplomas (including high school equivalency diplomas);
- marriage certificates;
- divorce decrees;
- property deeds or titles;
- a pay stub from a current employer with the applicant's name and address pre-printed, dated within 60 days of the application;
- census verification containing the applicant's name and address, dated not more than 12 months before the date of the application;
- a pension or retirement statement from a prior employer or pension fund stating the applicant's name and address, dated within 12 months of the application;
- tuition or student loan bill containing the applicant's name and address, dated not more than 12 months before the date of the application;
- utility bill, cell phone bill, credit card bill, doctor's bill or hospital bill containing applicant's name and address, dated not more than 60 days before the date of the application;
- valid homeowner's, renter's, or automobile insurance policy with pre-printed address, dated not more than 12 months before the date of the application, or a bill for such insurance with pre-printed address, dated not more than 60 days before the date of the application;
- lease dated not more than 12 months before the date of the application, or home mortgage identifying applicant and address; or
- employment verification by means of W-2 forms or other documents bearing the applicant's name and address submitted by the employer to a government agency as a consequence of employment.
- A finding of identity from a federal or state agency, including, but not limited to, a public assistance, law enforcement, internal revenue, or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual;
- A finding of identity from an Express Lane agency, as defined in section 1902(e)(13)(F) of the Social Security Act; or
- If you do not have any document listed in (1) through (3) above and your identity is not verified using the methods described in (4) or (5) above, you may submit an affidavit signed, under penalty of perjury, by another person who can reasonably attest to your identity. The affidavit must contain your name and other identifying information as described in (1) above. This affidavit does not have to be notarized.
If we asked you to verify citizenship or identity and you think you will need more time than we gave you on this notice, please call the phone number at the top of this notice to request an extension.
Other
Proof of Incarceration Status
Acceptable proof of incarceration status is a signed affidavit from the applicant or member indicating he/she lives in the community.
For people listed on this letter who need to provide proof of incarceration status, please circle the correct option below, sign and date. Then mail or fax this letter back. You can also call to provide this information. If more than one person on this letter needs to provide proof of incarceration status, use another piece of paper and give the requested information below including the person's signature and date. To get a copy of the Affidavit to Verify Incarceration Status you can also go to www.mass.gov/service-details/masshealth-member-forms.
- Person is not incarcerated.
- Person was recently released from prison.
- Person is incarcerated.
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