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State Plan Checklist - CERTIFICATION, ELIGIBILITY & COORDINATION OF SERVICES 8/14/2026 Page 20

b. Formal agreements for coordination of services include: [X] Responsibilities of each party [X] Assurance that information is used only for program eligibility and/or outreach [X] Assurance that information will remain confidential and not be shared with a third party

c. The State agency requires local agencies to coordinate services with, and/or develop referral systems for, the following (check all that apply): [X] SNAP [X] Children with special health care needs [X] TANF [ ] Schools [ ] SSI [X] Expanded Food and Nutrition Education Program (EFNEP) [X] Medicaid [ ] Other food assistance program (TEFAP, FDPIR, CSFP, etc.) [X] CHIP [X] Breastfeeding promotion [ ] IHS facilities [X] Child protective services [X] MCH (clinics/facilities) [X] Head Start [ ] Early and Periodic Screening, Diagnostic and Treatment (EPSDT) [X] Early Head Start [X] Family planning [ ] Healthy Start [X] Prenatal care [X] Substance abuse program