Immigration Status Documentation: The Healthy Families Program

For eligible qualified immigrants, the documents listed below can be used to show immigration status for the Healthy Families Program. If the document is two sided, send copies of both sides

•    An alien lawfully admitted for permanent residence under the Immigration and Nationality Act (INA)
      o  INS farm 1-551
      o  INS form 1-94 with a current 1-551 stamp on a foreign passport

•    An alien granted conditional entry pursuant to Section 203(a)(7) of the INA
      o  INS form 1-94 with a stamp showing admission under 203(a)(7) of the INA
      o  INS from I-688B showing admission under 274a.12(a)(3)

•    An alien paroled into the U.S. under Section 212(d)(5) of the INA for at least one year
      o  INS form 1-94 showing admission for at least one year under section 212(d)(5)
      o  Notice or court order from an Immigration Judge granting parole for at least one year

•    An alien with the appropriate immigration status who (or whose child or parent) has beenbattered or subjected to extreme cruelty in the United States and there is a substantial connection between the battery or extreme cruelty and the need for benefits, and who no longer resides in the household of the batterer
      o  Approved INS form 1-130
      o  INS form 360 petition filed under the Violence Against Women Act (VAWA)
      o  INS form 1-797 indicating filing of the 1-360 petition

•    An alien granted asylum under Section 208 of the INA
      o  INS form 1-94 showing grant of asylum under Section 208 of the INA
      o  INS form I-688B under section 274a.12(a)(5) 0 INS form 1-776 with the code "05"
      o  Grant letter from the asylum office or the USCIS
      o  An order from an Immigration Judge granting asylum

•    A refugee admitted to the U.S. under Section 207 of the INA
     o  INS form 1-94 showing admission as a Refugee under Section 207 of the INA
     o  INS form I-688B under Section 274a.12(a)(3)
     o  INS form 1-776 with code "A3"
     o  INS form 1-551 with code "RE"
     o  INS form 1-571

•    An alien whose deportation is being withheld by order of an Immigration Judge under Section 243(h) of the INA as in effect prior to April 111997, or whose removal is being withheld under Section 241 (b)(3) of the INA
     o  INS form 1-688B with the code 274a.12(a)(10)
     o  INS form 1-776 with the code "A10"

•    An alien who is a Cuban or Haitian entrant as defined in Section 501(e) of the Refugee Education Assistance Act of 1980
     o  INS form 1-551 with the codes CU6, CU7, or CH6
     o  Current 1-551 stamp with the codes CU6 or CUT on the INS form 1-94
     o  Current 1-551 stamp on a foreign passport with codes CU6 or CUT
     o   INS form 1-94 with stamp showing parole as a 'Cuban/Haitian entrant" under Section 212(d)(50) of the INA

•    Qualified aliens lawfully residing in any state who are honorably discharged veterans who fulfill minimum active duty service requirements or who are on non-training active duty in the U.S. Armed Forces
     o  DD form 214
     o  Military identification card if on active duty
     o  Current military orders

•    The spouse or unmarried dependent or the unmarried surviving spouse whose marriage satisfies the requirements of 38 U.S.C. 1304 of those veterans or persons on active duty described in the previous bullet (Qualified aliens lawfully residing in any state who are honorably discharged veterans)

•    Current military identification card to establish marital relationship to the veteran or parent-child relationship to the veteran

•    An American immigrant admitted to the U.S. pursuant to Section 584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1998 as described in Section 1612(a)(2)(A)(1)(V) of Title 8 of the United States Code
     o  INS form 1-551 with the code AM6, AM7, or AM8
     o  Current temporary 1-551 stamp in a foreign passport with the code AM1, AM2, AM3
     o  INS form 1-94 with the codes AM1, AM2, or AM3

Confidential Information Regarding Immigration information
CAAs may be asked questions about an applicant's immigration information that may be reported to U.S. Citizenship and Immigration Services (USCIS, formerly the INS). Information on page 3 of the application instructions, can help assure families that immigration information is only required for children and pregnant women and is not shared with the USCIS for services they lawfully receive. CAAs should explain the following:

•    “Information about children or pregnant woman listed on the application is confidential and is only shared with U.S. Citizenship and Immigration Services in case of fraud”
•    Information about the children’s or pregnant women’s Immigration that is listed on the join Healthy Families and Medi-cal for Families mail-in application is confidential
REMINDER:  Applicants are not required to provide information about their own immigration status unless they are applying for benefits for themselves.