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) ‎(38)
Section : A - Nutrition Education & Breastfeeding ‎(16)
Section : B - Food & Formula ‎(20)
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 ‎(19)
Section : A - Funds Allocation ‎(1)
Section : B - Local Agency Budgets ‎(10)
Section : C - Expenditures & Access to Funds ‎(5)
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 ‎(153)
Section : A - Eligibility Determination & Documentation ‎(17)
Section : B - Nutrition Risk Determination, Documentation, & Priority Assignment ‎(13)
Section : B - Nutrition Risk Determination, Documentation, & Priority Assignment Appendix ‎(80)
Section : C - Health Care Agreements, Referrals, & Coordination ‎(6)
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 ‎(18)
Section : B - Check Issuance ‎(7)
Section : C - Food Instrument Pick-up and Transaction ‎(1)
Section : C - Check Redemptions & Disposition ‎(2)
Section : C - Replacing eWIC Card ‎(1)
Section : D - Documentation of Check Issuance ‎(1)
Section : E - Special Check Issuance Accommodations ‎(1)
Section : E - Special Issuance Accomodations ‎(1)
Section : F - Special Formula Situations ‎(3)
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:

Formula Recall - Policy Memos (Issue Date)

02.18.22 - Guidance for Talking with Participants about the Abbot Formula Recall

02.23.22 - Abbott Formula Recall

06.7.22 update - Using Non-Contract Formulas During Abbott Recall

Formula Recall Participant Handouts

03.8.22 - Purchasing the Right Amount of Formula
03.8.22 - Purchasing the Right Amount of Formula (Spanish)

Effective until February 28, 2023

Effective until June 30, 2023

Other - Policy Memos

06.21.22 - New Non-Discrimination Statement
06.15.22 - Certifying Applicants While in the Hospital
11.18.21 - Medical Documentation (PAF) Waiver Ending
10.20.21 - CVB Increase for November & December 2021 - Assigning New Food Packages
10.06.21 - Services for Afghan Refugees
01.10.20 - e/WIC Journey use Outside of the Clinic

COVID-19 Policies & Resources

	Type	Name
Category : A. Policy Memos & Forms ‎(20)
Category : B. Other Guidance ‎(10)
Category : C. Job Aid ‎(4)
Category : D. FAQ ‎(3)

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Commonly Used Fillable Forms, Letters, Templates

Administrative Forms

Budget Form and Personnel Cost Summary

Budget Guidelines & Instructions
Budget Form FY2023
Personnel Cost Summary Table FY2023

Budget Narrative Form

WIC Administrative Budget Form FY2023
Budget Narrative

Per Diem Worksheet
FSR Pages 1, 2, 3
Journey - Add User Form - Journey Train access provided until new staff attends training
Journey - Remove User Form
Nebraska WIC Program Data Request Form
Request for Authorization of Purchase Form - Education and Promotion Materials
Request for Authorization of Purchase Form - Office/Clinic Equipment, Renovation, Repairs

Breastfeeding Aids and Accessories - Supporting Materials & Forms

Clinic Forms

Additional Benefit Issuance Form
Administration Materials Order Form
Educational Materials Order Form
Medicaid Phone Verification Access Request - Confidentiality Statement
Medicaid Web Verification Access Request - Confidentiality Statement
No Proof Fillable Form - Address
No Proof Fillable Form - Identity
No Proof Fillable Form - Income
Requesting Approval to Open, Close, or Move a Clinic
Termination Notice & Ineligibility Notices can be printed in Journey
WIC Infant Enrollment Form

Complaint Forms

Education Handout Assessment Forms

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

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

Vendor Change Forms

WIC COVID-19 Resources

	Type	Name
Category : A. Policy Memos & Forms ‎(20)
Category : B. Other Guidance ‎(10)
Category : C. Job Aid ‎(4)
Category : D. FAQ ‎(3)

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WIC Policies, Procedures, & Forms

What would you like to do?

What you need to know

WIC Procedure Manual

Policy Memos & Resources:

Formula Recall - Policy Memos (Issue Date)

Formula Recall Participant Handouts

COVID-19 Policies & Resources

Commonly Used Fillable Forms, Letters, Templates

Breastfeeding Aids and Accessories - Supporting Materials & Forms

Clinic Forms

Complaint Forms

Education Handout Assessment Forms

USDA Non-Discrimination Phrase

Vendor Change Forms

WIC COVID-19 Resources

More

More

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

What would you like to do?

What you need to know

WIC Procedure Manual

Policy Memos & Resources:

Formula Recall - Policy M​em​os (Issue Date)​

​

Formula Recall Participant Handouts

COVID-19 Policies & Resources​​

​​​Commonly Used Fillable Forms, Letters, Templates

Breastfeeding Aids and Accessories - Supporting Materials & Forms

Clinic Forms

Complaint Forms

Education Handout Assessment Forms

USDA Non-Discrimination Phrase

Vendor Change Forms

WIC COVID-19 Resources

More

WIC Policies, Procedures, & Forms

Formula Recall - Policy Memos (Issue Date)

COVID-19 Policies & Resources

Commonly Used Fillable Forms, Letters, Templates