WIC Policies, Procedures, & Forms

Public Health

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WIC Procedure Manual

	Type	Name	Procedure Type
Functional Area : 01. VENDOR ‎(20)
Section : A - Vendor Selection & Authorization ‎(8)
Section : B - Vendor Training ‎(5)
Section : C - High Risk Vendor Identification Systems ‎(1)
Section : D - Routine Monitoring ‎(2)
Section : F - Vendor Sanction System ‎(2)
Section : I - Staff Training on Vendor Management ‎(2)
Functional Area : 02. Nutrition & Breastfeeding (A) (B) (C) ‎(34)
Section : A - Nutrition Education & Breastfeeding ‎(14)
Section : B - Food & Formula ‎(18)
Section : C - Staff Training ‎(2)
Functional Area : 04. Organization & Management ‎(12)
Section : A - State Staffing ‎(1)
Section : B - Evaluation & Selection of Local Agencies ‎(2)
Section : B - Evaluation & Selection of Local Agencies Appendix ‎(2)
Section : C - Local Agency Staffing ‎(1)
Section : E - Clinic Operations, Scheduling, & Forms ‎(6)
Functional Area : 05. Nutrition Services & Admin ‎(17)
Section : A - Funds Allocation ‎(1)
Section : B - Local Agency Budgets ‎(10)
Section : C - Expenditures & Access to Funds ‎(3)
Section : D - Reporting & Reviewing FSR ‎(2)
Section : E - Nutrition Education Costs ‎(1)
Functional Area : 07. Caseload management ‎(9)
Section : A - No Show Rate ‎(1)
Section : E - Outreach Policies & Procedures ‎(5)
Section : F - Waiting List Management ‎(3)
Functional Area : 08. Certification, Eligibility and Coordination of Services ‎(156)
Section : A - Eligibility Determination & Documentation ‎(18)
Section : B - Nutrition Risk Determination, Documentation, & Priority Assignment ‎(12)
Section : B - Nutrition Risk Determination, Documentation, & Priority Assignment Appendix ‎(81)
Section : C - Health Care Agreements, Referrals, & Coordination ‎(8)
Section : D - Processing Standards ‎(2)
Section : E - Certification Periods ‎(8)
Section : F - Transfer of Certification ‎(2)
Section : G - Dual Participation, Participant Rights & Responsibilities, Fair Hearing Procedures, & Sanction System ‎(11)
Section : H - An Overview of WIC Services ‎(3)
Section : I - Application for WIC Benefits ‎(3)
Section : J - Confidentiality ‎(5)
Section : K - Records Management ‎(3)
Functional Area : 09. Food Delivery ‎(16)
Section : B - Check Issuance ‎(8)
Section : C - Food Instrument Pick-up and Transaction ‎(1)
Section : C - Check Redemptions & Disposition ‎(1)
Section : C - Replacing eWIC Card ‎(1)
Section : D - Documentation of Check Issuance ‎(1)
Section : E - Special Issuance Accomodations ‎(1)
Section : F - Special Formula Situations ‎(2)
Section : J - Return of Formula and Food ‎(1)
Functional Area : 10. Monitoring and Audits ‎(3)
Section : A - Monitoring ‎(2)
Section : B - Audits ‎(1)
Functional Area : 11. Civil Rights ‎(11)
Section : A - Administration ‎(3)
Section : B - Public Notification Requirements & Nondiscrimination Notification ‎(5)
Section : D - Data Collection & Reporting ‎(1)
Section : E - Complaint Handling ‎(2)

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Policy Memos & Resources:

Policy Memos

06.21.22 - New Non-Discrimination Statement
06.15.22 - Certifying Applicants While in the Hospital
10.06.21 - Services for Afghan Refugees
01.10.20 - e/WIC Journey use Outside of the Clinic

Commonly Used Forms, Letters, Templates, SmartSheets

Administrative Forms

Budget Table and Personnel Cost Summary

Budget Guidelines & Instructions
Budget Form
Personnel Cost Summary Table

Budget Narrative Template
Per Diem Worksheet
FSR Pages 1, 2, 3
Journey - Add User SmartSheet Form
Journey - Remove User SmartSheet Form
Nebraska WIC Program Data Request Form
Request for Additional Funds
Request for Additional Funds SmartSheet Form
Request for Authorization to Purchase (RAP Form)
Request for Budget Shift SmartSheet Form

Breastfeeding Aids and Accessories - Supporting Materials & Forms

Clinic Forms

Complaint Forms

Disaster Resources from COOP Plan

WIC Services Guide Book - Paper forms if Journey is down

Education Handout Assessment Forms

DANEH Checklist
Completed forms to be saved on the WIC Business Partner Site

SmartSheet Forms

Reference Guide for Smartsheets at NE WIC (includes links)

USDA Non-Discrimination Phrase

This document contains the USDA Non-Discrimination phrases required on Nebraska WIC materials. For questions about proper use, contact Marge Blankenship at marge.blankenship@nebraska.gov
USDA Non-Discrimination Statement

WIC Policies, Procedures, & Forms

What would you like to do?

What you need to know

WIC Procedure Manual

Policy Memos & Resources:

Policy Memos

Commonly Used Forms, Letters, Templates, SmartSheets

Breastfeeding Aids and Accessories - Supporting Materials & Forms

Clinic Forms

Complaint Forms

Disaster Resources from COOP Plan

Education Handout Assessment Forms

SmartSheet Forms

USDA Non-Discrimination Phrase

Vendor Change Forms

More

More

WIC Policies, Procedures, & Forms page description // <![CDATA[ _spBodyOnLoadFunctionNames.push("setupPageDescriptionCallout"); // ]]>

What would you like to do?

What you need to know

WIC Procedure Manual

Policy Memos & Resources:

​​Policy Memos

​​​Commonly Used Forms, Letters, Templates, SmartSheets

Breastfeeding Aids and Accessories - Supporting Materials & Forms

Clinic Forms

Complaint Forms

Disaster Resources from COOP Plan

Education Handout Assessment Forms

​SmartSheet Forms

USDA Non-Discrimination Phrase

Vendor Change Forms

More

WIC Policies, Procedures, & Forms

Policy Memos

Commonly Used Forms, Letters, Templates, SmartSheets

SmartSheet Forms