MNsure Account Request Form

Who should use this form: If you are unable to create an account online at MNsure.org, submit this form.

Verifying Your Identity

To request a MNsure account, you will need to supply copies of documents that verify your identity. Select a tab below for options.

Option 1
Option 2

Option 1. A government-issued ID

Submit a copy of ONE valid, government-issued identification. Common government-issued IDs include driver’s licenses and passports, although many kinds of documents are accepted (a full list is below).

Your ID must:
- Include your name, date of birth, and photo.
- Be issued by a government in the United States or by a foreign government. Although government IDs from outside the U.S. may be accepted, they may require additional time to review, and your request may be delayed.
- Be current and valid. If the document has an expiration date, it must NOT be expired.
Accepted government-issued identity documents include:
- Driver’s license (foreign or domestic)
- Identification card issued by U.S. federal, state or local government, including a Minnesota identification card
- Passport (foreign or domestic)
- Consular ID card and other government-issued identification card (foreign or domestic),
- Military dependent’s identification card
- Military identification card for active duty, reserve or retired personnel, including a Geneva Conventions Identification Card and a Common Access Card (DD Form 2)
- Native American tribal document
- S. Coast Guard Merchant Mariner card
- S. military card or draft record
- Voter registration card issued by a US state or territory
- Prison Identification card (federal or state)
- Order of Supervision (ICE Form I-220A and I-220B)
- One of the following documents issued by US Citizenship and Immigration Services or its predecessors:
  - Certificate of Naturalization (Form N-550, N-570, N-578)
  - Certificate of Citizenship (Form N-560, N-561, N-645)
  - United States Citizen Identification card (Form I-179 or I-197)
  - Permanent Resident or Resident Alien card (Form I-551 or I-151)
  - Employment authorization document with photograph (Form I-688, I-688A, I-688B, or I-766)
  - Northern Mariana card (Form I-873)
  - American Indian card (Form I-872)
  - Re-entry Permit/Refugee Travel Document (I-571)
  - Report of Deportable and Inadmissible Alien (Form I-213)
  - Border Crossing Card
- Canadian naturalization certificate
Option 2. Other documents

If you do not have a valid government-issued ID, you can use a combination of other documents to verify your identity. You must provide copies of TWO of the following documents:
- Birth certificate (foreign or domestic), including Certificate of Birth Abroad or Consular Report of Birth Abroad
- Certificate of Adoption (foreign or domestic) that includes the applicant’s full name and date of birth
- Divorce decree (foreign or domestic)
- Employer identification card
- High school or college diploma (including high school equivalency diploma)
- Marriage certificate (foreign or domestic)
- Property deed or title
- Social Security card
- A document with an individual taxpayer identification number (ITIN) issued by the Internal Revenue Service
- School identification card (with photograph and name)
- Arrival / Departure Record (Form I-94 / I-94A)
- Notice to Report (Form I-385)
- Notice to Appear (Form I-862)