421-4        PROOF OF QUALIFIED ALIEN STATUS

To be eligible for APA Adult Public Assistance , an alien must provide proof of his or her qualified alien status.  The following documents are acceptable for determining qualified alien status and whether the qualified alien meets the five-year limitation.

Note:  If an applicant presents a receipt indicating that he or she has applied to USCIS U.S. Citizenship and Immigration Services for a replacement document for one of the documents identified below, contact the USCIS U.S. Citizenship and Immigration Services to verify status by filing a Document Verification Request (G-845 form) with the local USCIS U.S. Citizenship and Immigration Services district office and attach a copy of the receipt.

• Lawful Permanent Resident  

• Form I-551, or

• For recent arrivals, a temporary I-551 stamp in a foreign passport or on Form I-94.

Note:  Form I-551 has replaced Forms I-151, AR-3, and AR-3a.  If an applicant presents one of these old forms as evidence of status, contact USCIS U.S. Citizenship and Immigration Services to verify status by filing a Document Verification Request (G-845 form) and attaching a copy of the old form.  Refer the applicant to USCIS U.S. Citizenship and Immigration Services to apply for a replacement card.

• Refugee

• Form I-94 annotated with stamp showing admission under section 207 of the INA Immigration & Nationality Act;

• Form I-688B annotated "274a.12(a)(3)";

• Form I-766 annotated "A3"; or

• Form I-571(Refugee Travel Document).

• Asylee  

• Form I-94 annotated with stamp showing grant of asylum under section 208 of the INA Immigration & Nationality Act;

• Form I-688 annotated "274a.12(a)(5)";

• Form I-766 annotated "A5";

• A copy of the grant letter from the Asylum Office of USCIS U.S. Citizenship and Immigration Services; or

• The alien's copy of the order of the immigration judge granting asylum.

• Parolee:  

• Obtain a currently valid Form I-94 that indicates the alien has been paroled pursuant to section 212(d)(5) of the INA Immigration & Nationality Act , with an expiration date of at least one year from the date issued or indefinite.

Note:  Form I-688B annotated "274a.12(a)(4)" or "274a.12(c)(11)" or I-766 annotated "A4 or C11" indicates status as a parolee but does not reflect the length of the parole period.  If an individual cannot provide Form I-94, contact USCIS U.S. Citizenship and Immigration Services to verify status and length of the parole period.

• Alien whose deportation has been withheld under Section 243(h) of the INA Immigration & Nationality Act or whose removal was withheld under section 241(b)(3) of the INA Immigration & Nationality Act :  

• An alien's copy of the order from an immigration judge showing deportation withheld under section 243(h) of the INA Immigration & Nationality Act as in effect prior to April 1, 1997, or removal withheld under section 241(b)(3) of the INA Immigration & Nationality Act ;

• Form I-688B annotated "274a.12(a)(10)";

• I-766 annotated "A10".

• Alien granted conditional entry under the immigration law in effect before April 1, 1980:  

• Form I-94 identifying the bearer as "REFUGEE-CONDITIONAL ENTRY" and a citation of section 203(a)(7).

• Battered spouse or child of U.S. citizen or permanent legal resident:  

All three of the following criteria must be met:

• An approved or pending petition with USCIS showing a prima facie case that the battered individual is protected under the Violence Against Women Act;

• Verification that the individual responsible for the battery or cruelty is no longer living in the household of the victim; and

• A determination by the DPA Division of Public Assistance case worker that there is a substantial connection between the abuse and the need for public assistance.

• Victims of Trafficking

• Letter of certification from the Office of Refugee Resettlement (ORR).  The caseworker must verify the validity of this letter and notify ORR of the benefits for which the individual has applied by calling the toll-free trafficking verification line at 1-866-401-5510.

• Form I-797a indicating Class T-1 Visa.

• Form I-797a indicating T-2 (spouse), T-3 (child),  T-4 (parent), or T-5 (unmarried sibling under 18 years on the date such alien’s T visa application was filed), known as a ”Derivative Visa.”

Note:  T status is valid for three years from the date of approval and is not renewable.  However, the individual may adjust to lawful permanent resident status within the 90-day period immediately preceding the expiration of T status.

• Special Immigrants

• Iraqi or Afghan passport stamped with one of the following Immigrant Visa Codes:  SI1, SI2, SI3, SI6, SI7, SI8, SQ1, SQ2, SQ3, SQ6, SQ7, SQ8 and Department of Homeland Security (DHSS Department of Health and Social Services (State)) stamp or notification on passport or I-94 showing date of entry.