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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 NO Can be utilized as a source if the state is made aware of information that requires verification of residency. 5. Temporary Assistance for Needy Families (TANF) YES NO NO NO NO NO NO NO NO NO NO NO NO NO NO Data source can be used, if needed, for Residency, Caretaker Relative, Household Comp. 6. Supplemental Nutrition Assistance Program (SNAP) YES NO NO NO NO NO NO NO NO NO NO NO NO NO NO Data source can be used, if needed, for Residency, Caretaker Relative, Household Comp. 7. Office of Child Support Enforcement YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES As reported. Cooperation with medical support. 8. State General Assistance Programs YES NO NO NO NO NO NO NO NO NO NO NO NO NO NO Data source can be used, if needed, for Residency, Caretaker Relative, Household Comp. 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) 12.2. PARIS YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES Utilized for interstate benefits. Can be utilized as a source if the state is made aware of information that requires verification of residency (as needed). MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 8