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Electronic Data Source To Be Used (Y/N) Social Security Number Citizenship Immigration Status Residency Age/DOB Pregnancy Household Composition Caretaker Relative Medicare Application for other Benefits Other Data Source Used at Applicatio n (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollme nt (Y/N) If Used for Post- Enrollment Frequency Used (i.e. monthly, quarterly) Comments 3. Vital Statistics YES NO YES NO NO NO NO NO YES NO NO NO YES YES NO Check at application and report of change such as legal adoption. Only use for caretaker relative at application if two caretakers claiming responsibility for the child or report of legal adoption. Will use as a back up for citizenship and if inconsistency with SSA data match 4. Department of Motor Vehicles (DMV) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO Alaska DPA does not have access to DMV data base. 5. Temporary Assistance for Needy Families (TANF) YES YES YES YES NO NO NO NO NO NO NO NO YES YES YES Other (specify in comments) Check at application, recertification and report of change only if there is a discrepancy in state eligibility database. Only used at renewal/post enrollment if there's been a change in immigrations status or 5 yr. bar. Only use for SSN if verified with SSA first. Only use for citizenship and immigration status if verified in accordance with Medicaid/CHIP rules. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 7