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Eligibility Factor Self-Attestation Accepted without Additional Verification (Y/N) Self-Attestation Accepted with Post-Eligibility Verification (Y/N) Electronic Data Source Used (Y/N) Reasonable Compatibility Standard Used Specify Reasonable Compatibility Standard for Income Ask for a Reasonable Explanation from the Individual (Y/N) Paper Documentation Required from the Individual (Y/N) Comments Caretaker Relative YES NO NO N/A N/A NO NO In most cases the states accepts self-attestation unless there is information in internal data sources or through the course of other verifications that indicates an inconsistency that would affect eligibility. For example, an individual claims themselves as a relative and the state has conflicting information. Medicare NO NO YES N/A N/A YES YES If the client attests that they have resolved the discrepancy with SSA or CMS (source of data) we will query the electronic data again before asking for documentation. Application for Other Benefits NO NO YES N/A N/A YES YES If the client attests that they have resolved the discrepancy with the other agency (SSA, PARIS, unemployment source of data) we will query the electronic data again before asking for documentation. Other: (Please describe any other eligibility factors in the space below) MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION A - Verification Procedures for Factors of Eligibility 5