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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 3. Vital Statistics YES NO YES NO NO YES NO NO NO NO NO YES YES NO NO Also as needed for Death, Marriage, Birth, Divorce 4. Department of Motor Vehicles (DMV) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 5. Temporary Assistance for Needy Families (TANF) YES NO NO NO YES YES NO YES YES NO NO NO YES YES NO used post-enrollment as changes occur. Can be use for residency if necessary post-enrollment. 6. Supplemental Nutrition Assistance Program (SNAP) YES NO NO NO YES YES NO YES YES NO NO NO YES YES NO used post-enrollment as changes occur. Can be use for residency if necessary post-enrollment. 7. Office of Child Support Enforcement YES NO NO NO NO NO NO NO NO NO YES NO NO NO YES Other (specify in comments) used post-enrollment as changes occur. 8. State General Assistance Programs NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 9. Women, Infants and Children Program (WIC) YES NO NO NO NO YES YES YES NO NO NO YES YES NO NO 10. State Income Tax NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 10