Obsolete Table VIII - Verification and Interface Match

Effective Date: June 1, 2025 - July 2025

Attempt to verify all factors of eligibility electronically before asking client to provide hard copy verifications. 731 outlines the various methods of verification. 731-3 explains when a verification method other than client statement must be used. 731-5 explains the collateral contact verification method.

This table shows the interface matches that are available and gives EXAMPLES of hard copy verifications that may verify the information you need, although not every example listed will verify all of the information shown under the Eligibility Factors column.

Any other reasonable method of verification can be used as long as it provides the information needed to determine eligibility.

Eligibility Factor	Interface or Match	Examples of Hard Copy Verification
U.S. Citizenship; Age; Identification	Electronic Interface SCHIP	See Table IV
Non-Citizen (INS) Status	Electronic Interface - Social Security screens, Alien Registration	Alien Registration Card Correspondence from the Department of Homeland Security
Social Security Number; Social Security Claim #	Electronic Interface Birth Record SAVE SCHIP SOLQ	Social Security Card SSA form 5028 or 2880 Birth Certificate showing SSN applied for Official Social Security document
Utah Residence; Resident of an Institution	Electronic Interface New Hire Registry Prisoner System Information	Current Utah Drivers license Employment payroll check stubs Current UTES registration House payment receipt Current rent receipt Utah telephone book listing (referenced) Tribal Record correspondence Children's residence usually follows that of parents Nursing home resident (unless placed by another state) Form 131- Affidavit of Intent to Become a Utah Resident; or other statement of intent to remain in Utah. Duty of Support
Relationship (Including Specified Relative); Paternity	Electronic Interface, Birth Record	Self-declaration of relationship (unless the agency has conflicting information) Birth Certificate Court Order Marriage Certificate DWS Form 941 - Acknowledgment of Paternity A valid "Voluntary Declaration of Paternity" filed with Vital Statistics County Records Adoption placement or finalization forms (placement forms may be used to determine that child is not with birth parents) Death records Divorce records Documents from other state agencies stating verified relationship
Duty of Support		Completed Application for Child Support Enforcement on each non-custodial parent
Pregnancy		Current physician's or nurse mid-wife’s statement Current statement from Planned Parenthood Statement from a health clinic
School Attendance		DWS form 126 Form 114 and telephone contact with school
Medicare Part A and/or Part B Coverage	Electronic Interface - Social Security Screens SOLQ	Medicare Card Official document from SSA
Blindness, Disability	Electronic Interface - Social Security Screens SOLQ (does not have start date. BDX shows the start date.)	Award letter from SSA or SSI Form 121
Incapacity	Electronic Interface - Social Security Screens	Disability established Doctor Statement (must show incapacity, person can’t work or care for children, date of onset, estimated ending date
Application for Medicare Part B	Electronic Interface - Social Security	Statement from other agency
American Indian/Alaska Native or descendants in the 1st or 2nd degree of a Federally recognized tribe member. * Copayment exemption requires verification of status after the client has had reasonable time to provide verification.		American Indian/Alaska Native (AI/AN) Tribal Identification/Enrollment Card with number/tribal census document issued by a federally recognized tribe indicating the individual's affiliation with the tribe. Certificate of Degree of Indian or Alaska Native Blood (CDIB) signed by the Bureau of Indian Affairs (BIA), or another document from BIA recognizing the person as American Indian/Alaskan Native. Tribal court documents containing identifying information such as name and the date of birth. Indian Health Services (IHS) document indicating the individual is eligible for IHS services as an American Indian/Alaskan Native. (Such documents must have identifying information about the individual. IE, name and date of birth.) AI/AN Descendent Documents of ascendent (parent or grandparent) the verifies status as member of federally recognized AI/AN tribe. Provider document: Birth certificate, tribal court document or IHS fact sheet showing lineal descent from ascendant to descendant. http://www.ncsl.org/research/state-tribal-institute/list-of-federal-and-state-recognized-tribes.aspx
Earned Income Note: When a more current data source is not available, verified income data that was received within the past six months at a SNAP or TANF determination may be used.
Wages; Self-Employment	Electronic Interface, Wages Work Number, Wages TRUV New Hire Registry	Employment payroll check stubs Employer's wage record Statement from employer Self-employment records Copy of most recent tax return SNAP and TANF income data received within the past six months
Training, Work Study		Award letter Contracts
Earned income in-kind (food, clothing, free housing, etc.)		Employer's records Statement from employer Written agreement
Unearned Income Note: When a more current data source is not available, verified income data that was received within the past six months at a SNAP or TANF determination may be used.
Social Security Benefits (SSA); Supplemental Security Income (SSI); VA Benefits; Retirement; Labor Union Benefits; Pensions; Annuity; Disability Compensation; Scholarships/loans; Tribal Income; Cash gifts and prizes	Electronic Interface, Social Security Screens SOLQ (does not show correct amount if deductions are being taken out of benefits. Compare both the BDX and the SOLQ to verify the correct amount is counted.)	Client statement of benefits until information appears on the SDX/BDX Award letter Legally acceptable copy of check Correspondence from issuing agency Form 114 Bank statement showing direct deposit specifying source of income Tribal Records SNAP and TANF income data received within the past six months
Unemployment Compensation	Electronic Interface, Unemployment	Statement from DWS Bank statement showing direct deposit
Alimony and Child Support	Electronic Interface, Recovery Services screens	County Clerk records Divorce decree or other court order about payments including judgment for past due amounts. Copies of checks received Statement from ORS
Dividend and Interest	Electronic Interface	Bank Statements, dividend letters or statements Currently posted saving passbook Current credit union statement Form 114 Internet on-line banking
Real Property Sales		Sales Contract Mortgage
Payment of household expenses by others		Client's statement Form 702 - Statement of Contribution Form 17 - Shared Household Shelter Costs
	Expenses
Health Insurance		Receipt for health insurance premiums paid Insurance records/billing statement Check stubs/statements showing amount paid by individual
Medicare Part A & B Premium Amounts	Electronic Interface - Social Security screens	Medicare Card Official document from SSA
Alimony and Child Support Paid Out	Electronic Interface, Recovery Services screens (Unemployment Claim Adjustment Field)	Court order showing alimony or child support owed and copies of checks showing payments made Income tax records
Shelter costs (waiver or nursing home cases)		Utility bills Mortgage/rental agreements Canceled checks
Medical bills owed		Copies of medical services received and current statement of amount owed Statement from provider of amount owed
	Assets
Checking/Savings, Credit Union; Shares; Retirement Fund	Electronic Interface	Copy of current statement from bank or credit union Savings passbook dated within 30 days Form 114 Internet on-line banking
Trusts		Trust documents
Vehicles: Automobile, Trailer, Camper, Boat, Snowmobile, Motorcycle, Farm/Business Equipment Water Craft	Electronic Interface, Motor Vehicles	Title Registration County Tax Records Current J.D. Power average condition trade-in value or if trade-in value is not available, use Low Retail Other reliable electronic resources such as Kelley Blue Book, ect. Local dealer appraisal, if necessary
Land/Acreage or Building in which you do not live		Deed Tax Notice Sales Contract County Property Tax Records
Money-Making Resources (rental/ personal property)		Leases Contracts Agreements Depending on type of property, obtain deeds, tax notices, statements from knowledgeable source of value, etc.
U.S. Savings Bonds	Electronic Interface	Examine the original bonds for: Face value, date of issue, and net value (statement from bank may be needed to get current value. Internet site to calculate current value - http://www.treasurydirect.gov/indiv/tools/tools_savingsbondcalc.htm
Stocks, Bonds; Convertibles	Electronic Interface	Stocks, Bonds, Convertibles Form 114 to "retaining" brokerage as to current market value
Life Insurance Burial Assets		Policies from issuing company: purchase contract Written statement from the issuing company as to cash value, whether there are accumulations and how much it is worth.
Tools / Cash		Client's statement as to value or amount
	Other
TPL: Auto No Fault, Health (hospital), Accident, Homeowners		Policies Insurance Card Written or verbal notice from ORS Client's statement
Verifying coverage group for Targeted Adult Medicaid		Form 42A, 43A or 44A HMIS interface