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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 5. Temporary Assistance for Needy Families (TANF) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO expect to use this in Phase 2 of system build by May 2015 6. Supplemental Nutrition Assistance Program (SNAP) NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO expect to use this in Phase 2 of system build by May 2015 7. Office of Child Support Enforcement YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES Other (specify in comments) Cooperation with child support enforcement is only required post-enrollment; Questions on application are marked as not required and will not delay eligiblity determination. 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 MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 6