Form In-1806 - Eligibility Verification For Entitlements Act Attestation (Page 3 of 3) in pdf

Page 3 of 3

Eligibility Verification for Entitlements Act Additional Required Documentation

Part B. If you are claiming United States citizenship, you must present one (1) of the following:

•

A valid Tennessee driver license or photo identification license issued by the Department of Safety;

•

A valid driver license or photo identification license from another state where the issuance requirements

are at least as strict as those in Tennessee, as determined by the Department of Safety;

•

An official birth certificate issued by a state, jurisdiction or territory of the United States, including Puerto

Rico, United States Virgin Islands, Northern Mariana Islands, American Samoa, Swains Island, or Guam;

provided that Puerto Rican birth certificates issued before July 1, 2010, shall not be recognized;

•

A United States government-issued certified birth certificate;

•

A valid, unexpired United States passport;

•

A United States certificate of birth abroad (DS-1350 or FS-545);

•

A report of birth abroad of a citizen of the United States (FS-240);

•

A certificate of citizenship (N560 or N561);

•

A certificate of naturalization (N550, N570 or N578);

•

A United States citizen identification card (I-197, I-179);

•

Any successor document of those listed at Tenn. Code Ann. §§ 4-58-103(c)(4)-(9); or

•

A social security number that may be verified with the Social Security Administration in accordance

with federal law (if you provided your social security number as part of your application for

licensure, no additional documentation is required; however, please be aware that efforts may be

made to verify any such number).

Part C. If you are claiming qualified alien status, you must present two (2) forms of documentation of

identity and immigration status, as determined by the United States Department of Homeland Security to

be acceptable for verification through the SAVE program. Such forms of identification may include:

•

I-327 (Reentry Permit);

•

I-551 (Permanent Resident Card);

•

I-571 (Refugee Travel Document);

•

I-766 (Employment Authorization Card);

•

Certificate of Citizenship;

•

Naturalization Certificate;

•

Machine Readable Immigrant Visa (with Temporary I-551 Language);

•

Temporary I-551 Stamp (on passport or I-94);

•

Unexpired Foreign Passport;

•

WT/WB Admission Stamp in Unexpired Foreign Passport

•

I-20 (Certificate of Eligibility for Nonimmigrant (F-1) Student Status);

•

DS-2019 (Certificate of Eligibility for Exchange Visitor (J-1) Status);

•

Any other document determined by the U.S. Department of Homeland Security to be acceptable through the

Systematic Alien Verification for Entitlements (SAVE) program created pursuant to the federal Immigration

Reform and Control Act of 1986.

Part D. If you are claiming qualified alien status, but you are unable

to present two (2) forms of

documentation as described in Part C, then you shall present at least one (1) such document as described

in Part C, which shall then be verified through the SAVE program.

Part E. If you are claiming that you are a foreign national not physically present in the United States,

please

contact the program issuing the license, registration, certification or other benefit for which you

are applying to provide such documentation as may be required to verify such status.

IN-1806 (Rev. 07/14) (V. 03/16)

RDA 10222

Form In-1806 - Eligibility Verification For Entitlements Act Attestation Page 3

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