WIC Policies, Procedures, & Forms

Public Health

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WIC Procedure Manual

	Type	Name	Procedure Type
Functional Area : 01. VENDOR ‎(22)
Section : A - Vendor Selection & Authorization ‎(8)
Section : B - Vendor Training ‎(6)
Section : C - High Risk Vendor Identification Systems ‎(1)
Section : D - Routine Monitoring ‎(2)
Section : D - Routine Monitoring Appendix ‎(1)
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 : A - Nutrition Education and Breastfeeding ‎(1)
Section : B - Food & Formula ‎(19)
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 ‎(17)
Section : B - Check Issuance ‎(7)
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

COVID-19 Policies & Resources

	Type	Name
Category : A. Policy Memos & Forms ‎(18)
Category : B. Other Guidance ‎(10)
Category : C. Job Aid ‎(5)
Category : D. FAQ ‎(3)

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Commonly Used Fillable Forms, Letters, Templates

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

Vendor Change Forms

Complaint Forms

Administrative Forms

Budget Form and Personnel Cost Summary
Budget Narrative Form
Expense Reimbursement Document 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

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 COVID-19 Resources

	Type	Name
Category : A. Policy Memos & Forms ‎(18)
Category : B. Other Guidance ‎(10)
Category : C. Job Aid ‎(5)
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

COVID-19 Policies & Resources

Commonly Used Fillable Forms, Letters, Templates

Clinic Forms

Vendor Change Forms

Complaint Forms

Administrative Forms

USDA Non-Discrimination Phrase

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

COVID-19 Policies & Resources​​

​​​Commonly Used Fillable Forms, Letters, Templates

Clinic Forms

Vendor Change Forms

Complaint Forms

Administrative Forms

USDA Non-Discrimination Phrase

WIC COVID-19 Resources

More

WIC Policies, Procedures, & Forms

COVID-19 Policies & Resources

Commonly Used Fillable Forms, Letters, Templates