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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 Application (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollment (Y/N) If Used for Post- Enrollment Frequency Used (i.e. monthly, quarterly) Comments 4. Department of Motor Vehicles (DMV) YES NO NO NO NO NO NO NO NO NO NO NO NO NO YES Other (specify in comments) The information may be used to assist in verifying residency if need be. The information contained in this data file may be accessed on an "as needed" basis 5. Temporary Assistance for Needy Families (TANF) YES NO NO NO NO YES NO NO NO NO NO NO NO NO YES Other (specify in comments) TANF information may be accessed at anytime to assist in clarifying questionable information, including household composition and caretaker relative status. If discrepancy identified, TANF can be used to verify pregnancy status. 6. Supplemental Nutrition Assistance Program (SNAP) YES NO NO NO NO YES NO NO NO NO NO NO NO NO YES Other (specify in comments) SNAP information may be accessed at anytime to assist in clarifying questionable information, including residency and household composition.. 7. Office of Child Support Enforcement NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 8. State General Assistance Programs YES NO NO NO NO YES NO NO NO NO NO NO NO NO YES Other (specify in comments) This information may be accessed at anytime to assist in clarifying questionable information, including residency and household composition. 9. Women, Infants and Children Program (WIC) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 10. State Income Tax NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 11. Commercial database: (Please describe any commercial databases in the space below) MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 9