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 ‎(154)
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 ‎(7)
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 ‎(14)
Section : B - Check Issuance ‎(6)
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:

Formula Recall Participant Handouts

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

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

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 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 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 Participant Handouts

COVID-19 Policies & Resources

Commonly Used Fillable Forms, Letters, Templates