MNsure Account Request Form

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

PDF Paper Forms

Download the PDF version of this form if you prefer to print and mail us your request.

MNsure Account Request Form (PDF) (English)
Daim Ntawv Thov Tsim Tus Account (PDF) (Hmong)
Foomka Codsiga Akoonka (PDF) (Somali)
Formulario de solicitud de cuenta (PDF) (Spanish)
Бланк запроса учётной записи (PDF) (Russian)
Đơn Yêu Cầu Tài Khoản (PDF) (Vietnamese)

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)