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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 Applicatio n (Y/N) Data Source Used at Renewal (Y/N) Data Source Used Post- Enrollme nt (Y/N) If Used for Post- Enrollment Frequency Used (i.e. monthly, quarterly) Comments 10. State Income Tax NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO not applicable 11. Commercial database: (Please describe any commercial databases in the space below) 13. Other: (Please describe additional electronic data sources in the space provided below) 12. PARIS* YES NO NO NO NO NO NO NO NO NO NO YES NO NO YES Quarterly Used to determine if individual has benefits in another state. Can be used for residency if needed post- eligibility due to a discrepancy. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 10