{"text_format":"1","workbook":"xlsx","n_sheets":2,"sheets":["Form","Key"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":1,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Form","index":0,"n_rows":32,"n_cols":5,"rows_kept":32,"cut":false,"hidden":false,"merged":[[12,1,12,4],[14,1,14,4],[18,1,18,4],[13,1,13,4],[16,1,16,4],[11,1,11,4],[9,1,9,4],[7,1,7,4],[0,1,0,4],[6,1,6,4],[3,2,3,4],[10,1,10,4],[29,1,30,4],[25,1,25,4],[28,1,28,4],[19,1,19,4],[15,1,15,4],[22,2,22,4],[23,2,23,4],[21,1,21,4]]}
[null,"Nebraska WIC Program Data Request Form \ncomplete all fields in BLUE                     "]
[]
[null,"Name",null,"Title"]
[null,"Organization"]
[null,"Direct Phone Number",null,"Email"]
[]
[null,"REQUEST INFORMATION"]
[null,"**WIC participant and vendor data is CONFIDENTIAL.**  Only aggregate data may be provided to those outside the WIC program.  Please have sufficient security measures in place to ensure no participant or vendor information provided by the WIC Help Desk will be seen by anyone but the intended recipient.  Allow a minimum of two (2) weeks for your request to be worked.  If you have questions, please contact the NE WIC Help Desk at 402-471-0911. Submit request to dhhs.wichelp@nebraska.gov."]
[]
[null,"PURPOSE & USE - Why is the data needed? Provide the reason for obtaining the data or summary report. Detail what would be accomplished by obtaining the information.  Will the data or report be used for clinic operations, outreach/retention, presentation, grant application or report or other use? \n\n"]
[]
[null,"SPECIFICATIONS - Detail the data elements included in this request such as participant category and status, local agency and clinics, time range or period to be included, etc. \n\nPlease do not specify a frequency at which to receive the data (i.e., annually, month, quarterly, etc.) because that cannot be accommodated.  If you will need the same data provided again at a future date, please make a new, individual request at that time. We are unable to accommodate mulitple requests on one form. If you are unsure as to whether or not you should submit more than request form, please contact the help desk for direction. "]
[]
[null,"Notes by State…"]
[null,"FORMAT for FINISHED PRODUCT - Describe what is envisioned as the final format for the data or report, such as excel file, PDF file, graph, table or chart, etc."]
[]
[null,"Notes by State…"]
[]
[null,"INTENDED AUDIENCE OR CUSTOMER, IF NOT REQUESTOR (Form not to be used for Public Records Requests)"]
[]
[]
[null,"REQUEST LOGISTICS"]
[null,"Submission Date"]
[null,"Date Needed"]
[]
[null,"DISPOSITION & DOCUMENTATION (FOR STATE USE ONLY)"]
[null,"Fulfillment Date","Worked By",null,"Disposition"]
[]
[null,"Other Notes...to include file location of work products and documentation, etc."]
[]
[]
[null,"12.19 22 version"]

{"sheet":"Key","index":1,"n_rows":8,"n_cols":1,"rows_kept":8,"cut":false,"hidden":false,"merged":[]}
[]
[]
[]
["Disposition"]
["fulfilled as requested"]
["fulfilled w/ modifications"]
["could not fulfill"]
["other"]