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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 A ts pplication for other Benefi Other Data Source Used at Application (Y/N) Data Sour ce Used at Rene wal (Y/N) Data Source Used Post- Enrollment (Y/N) If Used for Post- Enrollment Frequency Used (i.e., monthly, quarterly) Comments 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) As self-attestation is accepted for most non-financial eligibility factors, this resource is not a primary resource to verify non-financial eligibility. This resource may be reviewed at application, renewal, and/or due to a change in circumstance. 6. Supplemental Nutrition Assistance Program (SNAP) YES YES YES YES NO NO NO NO NO NO NO NO YES YES YES Other (specify in comments) As self-attestation is accepted for most non-financial eligibility factors, this resource is not a primary resource to verify non-financial eligibility. This resource may be reviewed at application, renewal, and/or due to a change in circumstance. 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 NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 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) Accurint for Government Eligibility (AFGE) YES NO NO NO NO NO NO NO NO NO NO YES YES YES NO As self-attestation is accepted for most non-financial eligibility factors, this resource is not a primary resource to verify non-financial eligibility, however this resource may provide information regarding incarceration and death. This resource may be reviewed at application, renewal, MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 7