| To be eligible for PeachCare for Kids™ your child(ren) must be a U.S. Citizen, certain qualified legal residents, refugees or asylees. |
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| When proof of Citizenship is required please fax or mail to: |
Fax 866-259-3404
PeachCare for Kids™
Post Office Box 2585
Atlanta, GA 30301-2585 |
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| Please fax or send in ONE from this list (for each child): |
| List #1: Documents to Establish Both U.S. Citizenship and Identity: | - U.S. Passport - The department of State issues passports. A U.S. passport does not have to be currently valid to be accepted as evidence of U.S. Citizenship as long as it was originally issued without limitations. - OR -
- Certification of Naturalization (N-550 or N-570) - Issued by the Department of Homeland Security for naturalization. - OR -
- Certificate of Citizenship (N-560 or N-561) - Issued by the Department of Homeland Security to individuals who derive citizenship through a parent.
| | If you send one of these, no other information will be required. | |
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| - OR - |
| If you do not have one of the documents above, |
| please fax or send in ONE from each list #2 & list #3 below (for each child): |
| If not sending from list #1 above, please include one item from both list #2 and from list #3 below to complete Citizenship and Identity verification: | | List #2: Other Documents to Establish U.S. Citizenship, if you did not provide a document from list 1 please provide ONE of the following documents: | - A U.S. public birth record (Birth Certificate) showing birth in: one of the 50 U.S. States, District of Colombia, American Samoa, Swain's Island, Puerto Rico, Virgin Islands of the U.S., Northern Mariana Islands, or Guam. - OR -
- Certification of Report of Birth (DS-1350) - OR -
- Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240) - OR -
- Certification of Birth Abroad (FS-545) - OR -
- United States Citizen Identification Card I-197 - OR -
- American Indian Card (I-872) - OR -
- Final Adoption Decree - OR -
- Extract of hospital record on hospital letterhead - OR -
- Life or Health or other insurance record showing a U.S. place of birth and was created at least 5 years before the initial application date
| | List #3: Evidence of Identity, if sending from list 2 above please provide ONE of the following: | - Identification card issued by federal, state, or local government agencies or entities - OR -
- School record that shows date and place of birth and parent(s) name (under age 16 only) - OR -
- Daycare or nursery school record showing date and place of birth - OR -
- A current state driver's license
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| Do not send original documents. Put family account number on all documents. |
| Please make clear copies of both sides of all documents before sending! |