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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) YES YES NO NO YES YES YES YES YES NO NO NO YES NO NO These data elements will not regularly be used at the time of application or renewal; however there may be extenuating circumstances that would require use of this data source. We have marked the data elements that could be available based on the information contained in this program data base. It does not mean that we will use this information for every applicant, but if it is needed, we will have access to it through this program. Only use for SSN if verified with SSA first. MAGI-BASED ELIGIBILITY VERIFICATION PLAN SECTION B2 - Use of Electronic Data Sources, Non-Financial 10