Page 8

ATTACHMENT A: DATA ELEMENTS I. Required Data Elements The electronic file for categorically eligible individuals shall include the following required data elements for each categorically eligible individual: a. Last Name b. Date of Birth c. Sex II. Optional Data Elements The electronic file for categorically eligible individuals may include the following optional data elements for each categorically eligible individual: d. First Name e. Middle Name f. Participant Identification Number g. Family Identification Number h. Endorser First Name i. Endorser Last Name j. Proxy 1 k. Proxy 2 l. Proxy 3 m. Proxy 4 n. Proxy 5 o. Proxy 6 p. Local Agency Name q. Clinic Name r. WIC Clinic Number s. Certification Start Date t. Certification End Date u. Termination Date v. Participant Status Code w. Date of Last Food Benefits to Use x. Date of Last Transaction y. Street Address 1 z. Street Address 2 aa. City bb. County cc. State dd. Zip Code ee. Primary Telephone Number ff. Secondary Telephone Number gg. Email Address