FAMILY INDEPENDENCE ADMINISTRATION Matthew Brune, Executive Deputy Commissioner

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1 FAMILY INDEPENDENCE ADMINISTRATIN Matthew Brune, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Stephen Fisher, Assistant Deputy Commissioner ffice of Procedures PLICY BULLETIN #11-69-ELI REVISINS T THE PRUCL ELIGIBILITY DESK AID (W-205JJ) Date: August 4, 2011 This procedure can now be accessed on the FIAweb. Please refer to the Alien Eligibility Desk Aid (LDSS-4579) f the qualified alien criteria Subtopic(s): Fms The purpose of this policy bulletin is to infm staff of revisions made to the PRUCL Eligibility Desk Aid (W-205JJ). Some noncitizens who do not meet the Federal qualified alien criteria may be eligible f certain New Yk State funded benefits if they can be considered Permanently Residing Under the Col of Law (PRUCL). Noncitizens are considered to be PRUCL if their presence in the United States is officially determined by the United States Citizenship and Immigration Service (USCIS) to be legitimate, and USCIS is allowing them to reside in the country f an indefinite period of time. PRUCL is neither an immigration status n a term of immigration law but a public benefit eligibility categy. Individuals found eligible under this categy may receive only (SNA) and are not eligible f (FA), Federally Participating (SNFP), Emergency f Families (EAF) Food Stamps (FS). ne of the conditions in which a noncitizen may be eligible f benefits under PRUCL is if he/she is granted a U Visa U Visa status. U Visa/ U Visa status may be granted to an alien and his/her family members when the applicant f such a Visa has suffered substantial physical mental abuse as a result of having been a victim of certain criminal activity. The criminal activity must have violated the laws of the U.S., its territies possessions and the applicant must: possess infmation concerning the criminal activity of which he/she has been a victim; and help, be likely to help, Federal, State local law enfcement in the investigation and prosecution of the criminal activity. HAVE QUESTINS ABUT THIS PRCEDURE? Call then press 3 at the prompt followed by 1 send an to FIA Call Center Fax fax to: (917) Distribution: X

2 PB #11-69-ELI Revised Pri to September 17, 2007, when the final federal rule on U Visas was issued, the USCIS granted interim relief to applicants deemed prima facie eligible f U non-immigrant status. Approved applicants were placed in deferred action status which allowed them to remain in the United States indefinitely and apply f wk authization. Previous editions of Fm W-205JJ indicated that only those who have been granted deferred action as interim relief f an application f a U Visa will be eligible f PRUCL status. After the effective date of the final rule (10/17/2007) the interim relief process ended. Applications f U Visas are now adjudicated with successful applicants being granted a U Visa U Visa stats. Fm W-205JJ now indicates that noncitizens who have been granted a U Visa U Visa status are considered PRUCL f benefit eligibility purposes. In addition to this change, the common documentation associated with this status is being revised. If a noncitizen presents one of the following, s/he may be considered eligible f PRUCL status: Unexpired U Visa; Fm I-797 indicating that U Visa status has been granted; Fm I-94 stamped U1, U2, U3, U4 ; Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12(a)(19) A19, 8 CFR 274a.12(a)(20) A20; Any other USCIS authitative document that verifies U Visa status Note: The status Aliens paroled f less than a year has been removed from the W-205JJ as it is currently included on the Alien Eligibility Desk Aid (LDSS-4579) and is identified by the Alien Citizenship Indicat (ACI) code T. Effective Immediately Attachments: Please use Print on W-205JJ PRUCL Eligibility Desk Aid (Rev. 08/04/11) Demand to obtain copies of fms. LDSS-4579 Alien Eligibility Desk Aid (Rev. 10/07) FIA Policy, Procedures, and Training 2 ffice of Procedures

3 Fm W-205JJ (page 1) Rev. 8/04/11 PRUCL Eligibility Desk Aid Human Resources Administration Independence Administration Description of Status WMS/ACI Code F Tempary F Medicaid I-94 annotated rder of Supervision ; Fm I-220B (rder of Supervision); Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a 12(c)(18) C18; Any other authitative document from the USCIS indicating an rder of Supervision. Relevant Date f Eligibility Medicaid¹ Food Stamp Aliens residing in the United States pursuant to an rder of Supervision under 241(a)(3) of the Immigration Nationality Act (INA). Aliens granted cancellation of removal pursuant to 240A of the INA. rder from the Executive ffice of Immigration Review (EIR) granting cancellation of removal; Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12(a)(10) A10; Any other authitative document from the USCIS indicating cancellation of removal. N/A No No Granted deferred action status, which defers their departure. Fm I-797 (Notice of Action) indicating approval of deferred action status; Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12(c)(14) C14; Any other authitative document from the USCIS indicating deferred action. ¹ Reminder: Undocumented immigrants and nonimmigrants may receive coverage f care and services f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible, certain types of care provided to chronically ill persons, such as alternate level of care in a hospital, nursing facility services, home care (including private duty nursing) and personal care. Pregnant women may be provided Medicaid at any time without regard to immigration status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus Program (CHPlus).

4 Fm W-205JJ (page 2) Rev. 8/04/11 PRUCL Eligibility Desk Aid Human Resources Administration Independence Administration Description of Status Spouse child of a U.S. citizen who has been granted a K Visa. WMS/ACI Code F Tempary F Medicaid Unexpired K2, K3, K4 Visa; Note: If an expired K Visa is submitted, then proof that an I-539 (Application to Extend/Change Nonimmigrant Status) was filed with USCIS must be submitted. Fm I-94 stamped K2, K3 K4 ; Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12(a)(9) A9; and SAVE clearance, Fm I-797 any other authitative USCIS document indicating an I-130 application is pending approved. Relevant Date f Eligibility Medicaid¹ Food Stamp Spouse child of a U.S. citizen who has been granted a K Visa and who: makes a claim of DV; does not have a grant of prima facie an approved I-360; and has a pending I-360 but refuses to go to DVL f credibility assessment is determined noncredible. Unexpired K2, K3, K4 Visa; Note: If an expired K Visa is submitted, then proof that an I-539 (Application to Extend/Change Nonimmigrant Status) was filed with USCIS must be submitted. Fm I-94 stamped K2, K3 K4 ; Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12(a)(9) A9; and SAVE clearance, Fm I-797 any other authitative USCIS document indicating an I-360 application is pending. N/A No No ¹ Reminder: Undocumented immigrants and nonimmigrants may receive coverage f care and services f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible, certain types of care provided to chronically ill persons, such as alternate level of care in a hospital, nursing facility services, home care (including private duty nursing) and personal care. Pregnant women may be provided Medicaid at any time without regard to immigration status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus Program (CHPlus).

5 Fm W-205JJ (page 3) Rev. 8/04/11 PRUCL Eligibility Desk Aid Human Resources Administration Independence Administration Description of Status Aliens granted S Visa status. Issued to aliens possessing reliable infmation regarding an imptant aspect of a crime terrist ganization plot. Aliens granted a U Visa U Visa status. U Visas statutily expire in 4 years. Extensions beyond 4 years are only possible in very limited circumstances. WMS/ACI Code F Tempary Unexpired S Visa; Fm I-94 stamped S5, S6 S7 ; Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12(c)(21) C 21; Any other USCIS authitative document that verifies S Visa status. Unexpired U Visa; Fm I-797 indicating that U Visa status was granted Fm I-94 stamped U1, U2, U3, U4 ; Unexpired Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12(a)(19) A19, 8 CFR 274a.12(a)(20) A20 Fm I-766 with categy codes A19, A20 and expiration date is less than 4 years from date of application; Any other USCIS authitative document that verifies U Visa status. F Medicaid Relevant Date f Eligibility Medicaid¹ Food Stamp N/A No No ¹ Reminder: Undocumented immigrants and nonimmigrants may receive coverage f care and services f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible, certain types of care provided to chronically ill persons, such as alternate level of care in a hospital, nursing facility services, home care (including private duty nursing) and personal care. Pregnant women may be provided Medicaid at any time without regard to immigration status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus Program (CHPlus).

6 Fm W-205JJ (page 4) Rev. 8/04/11 PRUCL Eligibility Desk Aid Human Resources Administration Independence Administration Description of Status Aliens granted V Visa status under the Legal Immigration Equity Act (LIFE Act) f spouses and children of LPRs. Aliens granted V Visa status under the Legal Immigration Equity Act (LIFE Act) f spouses and children of LPRs who: makes a claim of DV; does not have a grant of prima facie an approved I-360; and has a pending I-360 but refuses to go to DVL f credibility assessment is determined noncredible. Food Relevant Date f WMS/ACI Stamp Eligibility Medicaid¹ Code F Tempary F Medicaid Unexpired V Visa; Note: If an expired V Visa is submitted, then proof that Fm I-539 (Application to Extend/Change Nonimmigrant Status) was filed with USCIS must be submitted. Fm I-94 stamped V1, V2, V3 N/A No No Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12 (a)(14) A (14); and SAVE clearance, Fm I-797 any other authitative USCIS document indicating an I-130 application is pending approved. Unexpired V Visa; Note: If an expired V Visa is submitted, then proof that Fm I-539 (Application to Extend/Change Nonimmigrant Status) was filed with USCIS must be submitted. Fm I-94 stamped V1, V2, V3 ; Fm I-688B Fm I-766 (Employment Authization Document) categy 8 CFR 274a.12 (a)(15) A15; and SAVE clearance, Fm I-797 any other authitative USCIS document indicating an I-360 application is pending. N/A No No ¹ Reminder: Undocumented immigrants and nonimmigrants may receive coverage f care and services f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible, certain types of care provided to chronically ill persons, such as alternate level of care in a hospital, nursing facility services, home care (including private duty nursing) and personal care. Pregnant women may be provided Medicaid at any time without regard to immigration status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus Program (CHPlus).

7 Fm W-205JJ (page 5) Rev. 8/04/11 PRUCL Eligibility Desk Aid Human Resources Administration Independence Administration Description of Status Not qualified aliens who can produce any evidence, including but not limited to verification by USCIS that they entered the U.S. pri to January 1, 1972, and have resided continuously in the U.S. since such entry, pursuant to Section 249 of the INA. Any aliens living in the U.S. with knowledge and written permission of the USCIS and whose departure the Agency does not contemplate enfcing. Food Relevant Date WMS/ACI Stamp f Eligibility Medicaid¹ Code F Tempary F Medicaid Fm I-688B Fm I-766 coded 8 CFR 274a.12(c)(16) C16; Fm I-797 indicating Notice of Adjustment of Status to Permanent Resident pursuant to INA 249; January 1, 1972 Any letter/notice from the USCIS EIR No No indicating Registry Application (Fm I-485) is pending; Any documentary proof establishing entry and continuous residence. If documentation is submitted and the status of the alien does not fit in any of the other categies listed in this guide, the Wker must contact the ffice of Procedures who will contact the ffice of Tempary Disability to See Page 6 N/A No No determine if the alien meets PRUCL status. ¹ Reminder: Undocumented immigrants and nonimmigrants may receive coverage f care and services f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible, certain types of care provided to chronically ill persons, such as alternate level of care in a hospital, nursing facility services, home care (including private duty nursing) and personal care. Pregnant women may be provided Medicaid at any time without regard to immigration status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus Program (CHPlus).

8 Fm W-205JJ (page 6) Rev. 8/04/11 PRUCL Eligibility Desk Aid Human Resources Administration Independence Administration Description of Status Permanent nonimmigrants, pursuant to P.L (applicable to citizens of the Federated States of Micronesia and Marshall Islands). Applicants f asylum. Persons granted Tempary Protected Status. WMS/ACI Code F Tempary F Medicaid I-94 stamped CFA/MIS DS (Duration of Status); I-688B I-766 coded 8 CFR 274a.12(a)(8) A8. N/A N/A I-797 indicating Asylum Application received, pending intent to approve asylum request; I-688B I-766 coded 8 CFR 274a.12(c)(8) C8. I-797 indicating TPS status granted; I-688B I-766 coded 8 CFR 274a.12(a)(12) A12. Relevant Date f Eligibility Medicaid¹ Food Stamp N/A No No No Persons applying f Tempary Protected Status. N/A I-688B I-766 coded 8 CFR 274a.12(a)(19) C19. Applicants f adjustment of status. N/A I-688B I-766 coded 8 CFR 274a.12(c)(9) C9; I-797 indicating application received pending. Persons who have filed applications f adjustment of status under Section 245 of the INA and the USCIS has accepted as properly filed. N/A I-797 indicating application received, pending approved; Fm I-94 passpts with annotation adjustment application employment authized during status as adjustment application ; Fm I-688A coded 245A; Fm I-688B Fm I-766 coded 8 CFR 274a. 12 (c)(22) C22. ¹ Reminder: Undocumented immigrants and nonimmigrants may receive coverage f care and services f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible, certain types of care provided to chronically ill persons, such as alternate level of care in a hospital, nursing facility services, home care (including private duty nursing) and personal care. Pregnant women may be provided Medicaid at any time without regard to immigration status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus Program (CHPlus).

9 Fm W-205JJ (page 7) Rev. 8/04/11 PRUCL Eligibility Desk Aid Human Resources Administration Independence Administration Description of Status Any aliens living in the U.S. with knowledge and permission acquiescence of the USCIS and whose departure the Agency does not contemplate enfcing. WMS/ACI Code F Tempary F Medicaid I-797 Notice of Action indicating the USCIS has received, taken action on approved an application petition; A copy of a cancelled check to the USCIS; Crespondence to from the USCIS, showing that the person is living in the United States with the knowledge and permission acquiescence of the USCIS, and the USCIS does not contemplate enfcing the person s departure from the United States. Examples include, but are not limited to: Permanent nonimmigrants, pursuant to P.L (applicable to citizens of See Page 4 the Federated States of Micronesia and Marshall Islands); Applicants f asylum; Persons granted Tempary Protected Status, Persons applying f Tempary Protected Status include documents I-688B I-766 codes 8CFR 274a. 12(c)(19) C19; Applicants f adjustment of Status; Persons who have filed applications f adjustment of status under section 245 of the INA and the USCIS has accepted as properly filed. Relevant Date f Eligibility Medicaid¹ Food Stamp N/A No No No ¹ Reminder: Undocumented immigrants and nonimmigrants may receive coverage f care and services f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible, certain types of care provided to chronically ill persons, such as alternate level of care in a hospital, nursing facility services, home care (including private duty nursing) and personal care. Pregnant women may be provided Medicaid at any time without regard to immigration status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus Program (CHPlus).

10 LDSS-4579 (Rev. 10/07) ALIEN ELIGIBILITY DESK AID Page 1 Description of Status WMS/ ACI Code Relevant Date f Eligibility Medicaid 1 Food Stamp Refugees R I-94: stamped Admitted under Section 207 of the INA, Refugee, RE1, RE2, RE3, RE4 I-551: stamped R8-6, RE5, RE6, RE7, RE8 RE9 I-571: Refugee Travel Document I-688B: Employment Authization Document annotated with 8 C.F.R. 274a.12(a) (3) I-766: Employment Authization Document annotated a3 Entry Cuban/Haitian Entrants H I-94: stamped Cuban/Haitian Entrant (status pending), Section 212(d) (5) of the INA, Fm I-589 filed, CU6, CU7 I-94 stamp showing parole under Section 212(d)(5) of INA stamp showing parole in US on after 10/10/80 and reasonable evidence that parolee has been a National (citizen) of Cuba Haiti 2 I-551: stamped CU6, CU7, CH6 Tempary I-551 stamp in feign passpt. USCIS notice letter indicating ongoing exclusion deptation proceedings Status Granted Asylees A I-94: stamped Granted asylum under Section 208 of the INA I-551: Stamped AS1,AS2, AS3, AS6, AS7, AS8 I-688B: Employment Authization Card annotated with 8 C.F.R. 274a.12(a)(5) I-766: Employment Authization Document annotated (a5) Grant letter from USCIS Asylum ffice rder of an immigration judge granting asylum. 1 REMINDER: F Medicaid, undocumented aliens and tempary non-immigrants may receive coverage f care and services necessary f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible. Pregnant women may be provided Medicaid at any time without regard to alien status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus (CH Plus) program. 2 EXCEPTIN: This guideline does not apply when the individual was paroled solely to testify as a witness in a judicial, administrative legislative proceeding when the parolee is in legal custody pending criminal prosecution.

11 LDSS-4579 (Rev. 10/07) ALIEN ELIGIBILITY DESK AID Page 2 Description of Status WMS/ ACI Code Relevant Date f Eligibility Medicaid 1 Food Stamp Amerasian Immigrants R I-94: stamped AM1, AM2, AM3, AM6, AM7, AM8. Derive date of entry from date of inspection on stamp; if date is missing, obtain from I-551 from USCIS I-551: stamped AM1, AM2, AM3, AM6, AM7, AM8 Tempary I-551 stamp in feign passpt 1-571: Refugee Travel Document Vietnamese exit visa passpt stamped AM1, AM2, AM3 Entry Deptation Removal Withheld Certain Hmong Highland Laotian J Z R (MA) I-688B: Employment Authization Card annotated with 8 C.F.R. 274a.12(a)(10) I-766: Employment Authization Document annotated (a10) rder from Immigration Judge showing the date deptation was withheld under Section 243(h) of the INA as in effect pri to April 1, 1997, removal withheld under Section 241(b)(3) of INA I-94: stamped Admitted under Section 207 of the INA, Refugee, RE1, RE2, RE3, RE4 INS I-551: Stamped RE5, RE6, RE7, RE8, RE9 Has a signed affidavit swn under penalty of law that s/he was a member of Hmong Highland Laotian tribe between 8/5/64 and 5/7/75 a verified spouse*, widow, widower unmarried dependent of a tribal member and Documents to show lawfully residing in the US Status Granted *Divced spouses do not qualify 1 REMINDER: F Medicaid, undocumented aliens and tempary non-immigrants may receive coverage f care and services necessary f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible. Pregnant women may be provided Medicaid at any time without regard to alien status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus (CH Plus) program.

12 LDSS-4579 (Rev. 10/07) ALIEN ELIGIBILITY DESK AID Page 3 Description of Status * Lawfully Admitted F Permanent Residence (LPR) with 40 Qualifying Quarters WMS/ ACI Code S I-551: (Permanent Resident Card) Tempary I-551 stamp in feign passpt on I-94 I-327: (Re-entry Permit) I-181: Memandum of Creation of Lawful Permanent Residence with approval stamp Relevant Date f Eligibility Entered Befe Entered n/after 0 Medicaid 1, after 5 years in US in a qualified status Food Stamp Lawfully Admitted F Permanent Residence (LPR) without 40 Qualifying Quarters Veteran, spouse, unmarried surviving spouse and unmarried dependent child of a U.S. veteran who fulfilled minimum active duty requirement (2 years) Active Military: Active duty a member of the Armed Fces on full-time duty in the Army, Navy, Air Fce, Marine Cps Coast Guard, spouse and children Conditional Entrant (status granted to refugees befe 1980) K V M F and Proof of qualifying quarters I-551: (Permanent Resident Card) Tempary I-551 stamp in feign passpt on I-94. I-327 (Re-entry Permit) I-181: Memandum of Creation of Lawful Permanent Residence with approval stamp A Discharge Certificate (Fm DD-214) that states Honable. A character of discharge Under Honable Conditions is not an Honable Discharge f these purposes. Narrative Reason f Separation block must not state that discharge was f reason of alienage lack of U.S. citizenship. Military Identification Card (DD Fm 2) (Active) that lists an expiration date of me than one year from the date of determination. If ID card is due to expire within one year from the date of determination, use a copy of current military ders. I-94 with stamp showing admitted under Section 203(a)(7) of INA I-688B (Employment Authization Card) annotated 274a.12(a)(3) I-766 (Employment Authization Document) annotated (A1) (A3) Entered Befe Entered n After 0 Status Granted Status Granted, after 5 years in US in a qualified status *No quarters earned after 12/31/96 may be counted in which an alien has received a Federal means-tested public benefit (FA, SSI, Food Stamps Medicaid.) Entry if: status and in receipt of certain disability benefits [7 USC 2012(r)] After five years in US in a qualified status status and under age 18 1 REMINDER: F Medicaid, undocumented aliens and tempary non-immigrants may receive coverage f care and services necessary f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible. Pregnant women may be provided Medicaid at any time without regard alien status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus (CH Plus) program.

13 LDSS-4579 (Rev. 10/07) ALIEN ELIGIBILITY DESK AID Page 4 Description of Status WMS/ ACI Code Relevant Date f Eligibility Medicaid 1 Food Stamp Entered Befe A US citizen s LPR s battered spouse, child, parent child of such battered person, who obtains "Notice of Prima Facie Case from USCIS under the Violence Against Women Act (VAWA) A U.S. citizen s LPR s battered spouse, child, parent child of such battered person, whose I-360 self petition under VAWA is approved A U.S. citizen s LPR s battered spouse child parent child of such battered person, whose I-360 self-petition under VAWA is pending and is determined to be a credible victim of domestic violence by the social service district s Domestic Violence Liaison (DVL) B 3 I-797 (Notice of Action) indicating prima facie eligibility of an I-360 self-petition under INA Section 204(a)(1)(A) (iii) (iv); INA Section 204(a)(1)(iii)(B) (i ) (iii) I-797 (Notice of Action) indicating approval of an I-360 self-petition under INA Section 204(a)(1)(A)(iii) (iv), INA Section 204(a)(1)(iii)(B) (i) (iii) I-797 (Notice of Action) indicating pending I- 360 self-petition under INA Section 204(a)(1)(A)(iii) (iv), INA Section 204(a)(1)(iii)(B) (i) (iii) Entered n/after The relevant date f eligibility is the date qualified status was obtained Entered Befe Entered n/after The relevant date f eligibility is the date qualified status was obtained Entered Befe Entered n/after The relevant date f eligibility is the date qualified status was obtained, after 5 years in US in a qualified status, after 5 years in US in a qualified status, after 5 years in US in a qualified status if: status and in receipt of certain disability benefits [7 USC 2012(r)] After five years in US in a qualified status status and under age 18 status and have 40 qualifying quarters

14 LDSS-4579 (Rev. 10/07) ALIEN ELIGIBILITY DESK AID Page 5 Description of Status WMS/ ACI Code Relevant Date f Eligibility Medicaid 1 Food Stamp An alien determined to be a credible victim of domestic violence by the social services district s DVL with a pending approved I-130 petition I-797 (Notice of Action) indicating approval pending I-130 visa petition under Section 201(b) of the INA (spouse child of a U.S. citizen) Section 203(a)(2)(A) (spouse child of a permanent legal resident); I-94 coded K3, K4, V1, V2 CR -1-7 and a pending approved I-130; Any other USCIS document indicating the alien has a K V visa and a pending approved I-130; I-688B I-766 (Employment Authization Documents) annotated (a)(9) (a)(15) Entered Befe Entered n/after The relevant date f eligibility is the date qualified status was obtained, after 5 years in US in a qualified status An application f VAWA cancellation of removal suspension of deptation has been granted is pending and the immigration court finds that applicant has a prima facie case f this relief B 3 (Cont d.) rder from the Executive ffice of Immigration Review (EIR) under INA 240A(b) if the application is pending documentation that the court finds that the applicant has a prima facie case f this relief Entered Befe, if: status and in receipt of certain disability benefits [7 USC 2012(r)] After five years in US in qualified status status and under age 18 status and have 40 qualifying quarters Entered n/after The relevant date f eligibility is the date qualified status was obtained, after 5 years in US in a qualified status

15 LDSS-4579 (Rev. 10/07) ALIEN ELIGIBILITY DESK AID Page 6 Description of Status Victim of Human Trafficking Parolee (f at least one year) (Non-citizens who have been allowed to come into the U.S. f humanitarian public interest reasons) Parolee (f less than one year) Nth American Indian bn in Canada 1 WMS/ ACI Code D (Upstate) R (NYC) G T To be determined (PA) C (MA) Certification Document (f adults) Eligibility Letter (f children) from the ffice of Refugee Resettlement (RR); Must call f verification I-94 Coded T1, T2, T3, T4 T5 stating admission under Section 212(d)(5) of the INA if status granted f at least one year I-94 with annotation Paroled pursuant to Section 212(d)(5) parole PIP with date of entry and date of expiration indicating one year I-688B annotated 8 CFR Section 274a 12(a)(4) 274(a) 12(c)(11) I-766 annotated C11 A4, and I-94 indicating admitted f at least one year I-94 with annotation Paroled pursuant to Section 212(d)(5) parole PIP I-688B coded 274a.12(a)(4) 274a12(c) (11) I-766 coded A4 C11 I-551: (Permanent Resident Card): stamped S1-3, tempary I-551 stamp in a Canadian passpt I-94: stamped S1-3 Tribal document certifying at least 50% American Indian blood, as required by Section 289 of the INA documented member of a federally recognized tribe and School recds, A birth baptismal certificate issued on a reservation, ther satisfacty evidence of birth in Canada Relevant Date f Eligibility Entry 4 Entered befe Entered on after Medicaid 1, after 5 years in US in a qualified status Food Stamp, if: status and in receipt of certain disability benefits [7 USC 2012(r)] After five years in US in qualified status status and under age 18 status and have 40 qualifying quarters NA No No NA REMINDER: F Medicaid. undocumented aliens and tempary non-immigrants may receive coverage f care and services necessary f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible. Pregnant women may be provided Medicaid at any time without regard to alien status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus (CH Plus) program. 4 F a Victim of Human Trafficking, ENTRY means the date of Certification by the ffice of Refugee Resettlement (RR) See 03 ADM-1.

16 LDSS-4579 (Rev. 10/07) ALIEN ELIGIBILITY DESK AID Page 7 Description of Status WMS/ ACI Code Relevant Date f Eligibility Medicaid 1 Food Stamp Member of federally recognized tribe bn outside U.S. To be determined (PA) C (MA) Membership card other tribal document demonstrating membership in a federally recognized Indian tribe under Section 4(e) of the Indian Self-Determination and Education Act NA PRUCL (not in any of above statuses) (PA & MA) See GIS 07 TA/DC001 See MM 04 ADM-7 AND 07 HIP INF-2 NA 5 No 5 5 No Undocumented immigrants nonimmigrants (aliens with a tempary immigration status) E NA Treatment of emergency medical condition only 1 No 1 REMINDER: F Medicaid, undocumented aliens and tempary non-immigrants may receive coverage f care and services necessary f the treatment of emergency medical conditions only, not including care and services related to an gan transplant procedure, if otherwise eligible. Pregnant women may be provided Medicaid at any time without regard to alien status, if otherwise eligible. Children may be provided medical assistance without regard to immigration status under Child Health Plus (CH Plus) program. 5 PRUCL refers to aliens who are permanently residing in the US under Col of Law. TDA s and the Department of Health s (DH) interpretation of PRUCL is different. A description of TA PRUCL can be found in GIS 07 TA/DC001. A description of MA PRUCL can be found in MM 04 ADM-7 and 07 HIP INF-2. United States Citizenship and Immigration Services (USCIS Fmerly INS) Documents I-94 Arrival/Departure Recd I-571 Refugee Travel Document I-130 Petition f an Alien Relative I-688 Tempary Resident Card I-181 Memandum of Creation of Recd of Lawful Permanent Residence I-688A Employment Authization F Legalization Applicants I-327 Reentry Permit of Permanent Residents I-688B Employment Authization Card I-360 Special Immigrant Petition I-766 Employment Authization Card I-485 Application to Register Permanent Residence to Adjust Status I-797 Notice of Action (1-797C current version) I-551 Legal Permanent Resident Card, Resident Alien Card green card Footnotes f Pages 4 and Page 5 3 There are four requirements f qualified battered alien status: 1. Be a credible victim of battery extreme cruelty; and 2. Have appropriate immigration documentation; and 3. Be able to show a substantial connection between the need f benefits and the battery extreme cruelty; and 4. No longer reside in the same household as the abuser.