Effective Date: 



Updated: 1/1992


To inform clients what evidence of age, identity, and citizenship or lawful admission is required by the Social Security Administration (SSA).


When to Prepare

Certification staff use Form H1106-A with the computer-printed Form H1106, Enumeration Referral, to inform clients what evidence is required by SSA.

Number of Copies and Transmittal

Certification staff attach one copy of Form H1106-A to the computer-printed Form H1106 and give or mail both forms to the client.

Form Retention

There is no retention requirement.


The form is self-explanatory.

Note: When processing Form H1106 at a TANF periodic review with a 60-day completion deadline, indicate on the top of Form H1106-A that Form H1106 must be returned by SSA by the 60th day after it is given to the client.

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