Formidable Forms
This form is utilized to issue benefits to a participant's WIC Card without requiring his or her signature.
What is the WIC 318 (Delayed Benefits Signature Authorization)?
The WIC personnel that have breastfeeding promotion and support responsibilities included in their EWPs or job description.
Who are all WIC personnel?
WIC Participants must receive food benefits within this period of time from the last date to spend on the most recently issued eWIC benefits to avoid termination from the program?
What is 90 days?
Children up to this age must be screened and referred for immunizations.
The federal department that administers the grant that funds the WIC Program.
What is the USDA?
This form is necessary to change a participant's food prescription to something outside of the normal food package.
What is the WIC 395 (Virginia Request for Special Food Prescription)?
Name one condition in which it is contraindicated to breastfeed (according to WIC Policy & Procedure).
What is AIDS or HIV, drug and alcohol abuse, Human T-Cell Leukemia Virus Type 1 (HTLV-1), active TB, infant with galactosemia? Accept one answer.
What is the WIC Participant Handbook?
Name one category of nutritional risk.
What is anthropometric, hematological, dietary, other nutrition or medical condition? Accept one.
More than _____ of all infants born in the United States are served by the WIC Program.
What is 50%?
This form is used to provide WIC services to applicants/participants that are exempt from documentation requirements by federal regulations (ex. homeless or migrant families).
What is the WIC 383 (Affidavit Form)?
Advertisements, printed materials, and bottles or cans containing this is not allowed to be visible in the WIC clinic.
What is formula?
Participants have the right to disagree with WIC staff regarding the outcome of their eligibility by asking for this.
What is a fair hearing?
A participant that has Medicaid, SNAP, TANF, FAMIS Plus with a $2 copay, or a family member receiving Free or Reduced Lunch through the National School Lunch Program is considered to have this.
What is adjunctive financial eligibility? Also accept adjunctive eligibility.
The number of health departments in the United States that operate a local WIC agency.
What is 50?
This form is used monitor characteristics of populations served to comply with Federal Civil Rights laws.
What is the WIC 415 (Racial/Ethnic Data Collection) Form?
WIC Local Agencies are required to provide this type of area for breastfeeding mothers.
What is comfortable and discreet?
The form number for the Participants Rights and Responsibilities.
What is the WIC-310?
Participants can transfer between overseas or out of state WIC offices using this document.
What is a WIC VOC (Verification of Certification)?
WIC is an entitlement program. True or False.
What is False?
This form is necessary for the sharing of WIC participant's information.
What is the WIC 309 (Release of Information)?
This person is to be contacted for any issues that are outside of the scope of the WIC Breastfeeding Peer Counselor.
Who is the WIC Designated Breastfeeding Expert?
If a WIC staff member is exposed to blood or bodily fluids of a participant, what viral infections will the participant's blood be tested for?
What is HIV, Hepatitis B &C?
Name the four requirements of eligibility for the WIC Program.
What are categorical, residential, financial and nutritional risk?
These three benefits are provided to WIC participants.
What are supplemental nutritious foods, nutrition education/counseling, and screening and referrals to other health, welfare and social services?