Policy and Procedures Manual – Women, Infants and Children

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Introduction	Policy Number	Effective Date	SWO Team
WIC Policy and Procedure Manual Overview	Overview	8/13	OT

I. Intake
Processing Standards and Appointments	INT 01.0	8/13	OT
Alternative Hours	INT 02.2	8/13	OT
Processing Electronic Application	INT 02.3	8/13	OT

II. Certification
Eligibility Overview	CRT 01.0	8/13	OT
Certification Visit Overview	CRT 01.1	8/16	OT
Immunization Screening & Referral	CRT 01.1.1	8/13	NT
Categorical Eligibility	CRT 02.0	8/13	OT
Proof of Identification	CRT 03.0	2/17	OT
Residential Eligibility	CRT 04.0	8/13	OT
Certification of Homeless/Institutionalized	CRT 04.1	8/13	OT
Financial Eligibility	CRT 05.0	8/16	OT
Adjunctive Financial Eligibility	CRT 05.1	3/19	OT
Income Eligibility	CRT 05.2	8/13	OT
Proof of Income	CRT 05.2.1	9/23	OT
Gross Income	CRT 05.2.2	8/13	OT
Income Exclusions	CRT 05.2.3	8/13	OT
Military Proof of Financial Eligibility	CRT 05.2.4	11/16	OT
Migrant / Homeless Income Eligibility	CRT 05.2.5	8/13	OT
WIC Program Income Guidelines	CRT 05.2.6	6/24	OT
Nutrition Eligibility - Overview	CRT 06.0	8/13	NT
Determine Nutrition Risk - Anthropometric	CRT 06.1	8/17	NT
Determine Nutrition Risk - Hematological	CRT 06.2	6/18	NT
Determine Nutrition Risk – Dietary	CRT 06.3	8/13	NT
Determine Nutrition Risk - Other Nutr. / Medical Cond	CRT 06.4	8/13	NT
Table A: Virginia WIC Program Nutrition Risks	CRT 06.5	8/13	NT
Certification & Changes to Certification Period	CRT 07.0	8/13	OT
Coordination of Services and Referral Systems	CRT 08.0	8/13	NT
Medicaid and Social Services Referrals	CRT 08.0.1	8/13	NT
Drug and Substance Abuse Referrals	CRT 08.0.2	8/13	NT
Blood Lead Referrals	CRT 08.0.3	8/13	NT
Breastfeeding Referrals	CRT 08.0.4	8/13	NT
Ineligibility	CRT 09.0	8/13	OT
System Termination from the WIC Program	CRT 09.1	3/19	OT
Subsequent Certifications	CRT 11.0	3/19	OT
WIC Out-Of-State Transfer Card - Issuance	CRT 13.0	5/16	OT
WIC Verification of Certification Card Acceptance	CRT 13.1.1	8/16	OT
In-State Transfers	CRT 13.2	8/13	OT

III. Nutrition Education
Nutrition Education Overview	NEd 01.0	8/13	NT
Nutrition Education Materials	NEd 01.1	8/13	NT
Nutrition Education Contacts	NEd 02.0	8/13	NT
Nutrition Education Contact - Initial	NEd 02.1	8/13	NT
Nutrition Education Contact-Follow-up, Low Risk	NEd 02.2	8/13	NT
Nutrition Education Contact - Follow-Up, High Risk	NEd 02.3	8/13	NT
Nutrition Education Methods	NEd 03.0	8/13	NT
Nutrition Education - Individual Counseling	NEd 03.1	8/13	NT
Nutrition Education - Group	NEd 03.2	8/13	NT
Nutrition Education - Web Based	NEd 03.3	8/13	NT
Nutrition Staffing Levels	NEd 04.0	8/13	NT
Exit Counseling Session for Women	NEd 08.0	8/13	NT
Mid-Certification Assessment	NEd 09.0	10/22	NT

IV. Breastfeeding
Breastfeeding Promotion and Support	BF 01.0	1/25	NT
Local Agency Breastfeeding Coordinator	BF 01.1	1/25	NT
Designated Breastfeeding Expert (DBE) Qualifications and Responsibilities	BF 01.2	3/22	NT
Breastfeeding Peer Counselors Qualifications and Responsibilities	BF 01.3	1/25	NT
Breast Feeding Contact Guidelines	BF 01.4	1/25	NT
Breastfeeding Education	BF 02.0	1/25	NT
Breastfeeding Supplies	BF 04.0	1/25	NT
Manual Breast Pump	BF 04.1	1/25	NT
Personal Use Electric Breast Pump	BF 04.2	1/25	NT
Multi-User Electric Breast Pump	BF 04.3	1/25	NT
Supplemental Nursing System (SNS)	BF 04.4	3/22	NT
Breastfeeding Breast Pads	BF 04.6	8/13	NT
Breastfeeding Nipple Shields	BF 04.7	1/25	NT
Breastfeeding Contraindications	BF 05.0	8/13	NT

V. Food Delivery Services
Allowable Foods	FDS 01.0	8/13	NT
Allowable Food Selection Criteria	FDS 01.1	11/16	NT
Food Packages	FDS 02.0	8/13	NT
Prescribing the Food Package	FDS 02.1	8/13	NT
Maximum Food Allowed	FDS 02.2	10/14	NT
Food Package I and II - Infant	FDS 02.2.1	8/13	NT
Food Package III - Special Needs	FDS 02.2.2	10/14	NT
Food Package IV Child	FDS 02.2.3	10/14	NT
Food Package V - Pregnant and Providing Mostly Breast Milk	FDS 02.2.4	10/14	NT
Food Package VI- Postpartum	FDS 02.2.5	10/14	NT
Food Package VII - Fully Breastfeeding	FDS 02.2.6	10/14	NT
Tailoring Food Packages	FDS 02.3	8/13	NT
Lactose Reduced / Lactose Free Food Pkg	FDS 02.3.1	8/13	NT
Convenience Food Package	FDS 02.3.2	8/13	NT
Calcium Fortified Juice	FDS 02.3.4	8/13	NT
Soy Milk Substitution	FDS 02.3.5	10/14	NT
Changing a Food Package	FDS 02.4	8/13	NT
Addition of Juice / Cereal to Infant Food Package	FDS 02.4.1	8/13	NT
Contract Infant Formula	FDS 03.1	8/13	NT
Medical Documentation for Special Formula and Supplemental Foods	FDS 03.2	8/13	NT
Returned Formula Issuance and Inventory	FDS 03.2.1	7/20	NT
Special Formula Ordering	FDS 03.2.2	8/18	NT
Formula/Medical Foods for Medicaid Participants	FDS 03.2.3	8/13	NT
Medicaid Verification Over the Maximum of Formula	FDS 03.2.4	11/14	NT
Approved Formulas	FDS 03.3	8/13	NT
Non-Approved Formula / Products	FDS 03.4	8/13	NT
Security of eWIC Cards and Card Sleeves	FDS 04.1	8/13	OT
Food Benefits Issuance	FDS 04.2	3/19	OT
Food Benefit Issuance without Physical Presence	FDS 04.2.1	8/17	NT
Prorating of Food Prescriptions	FDS 04.4	8/13	NT
Voiding Food Benefits	FDS 04.6	8/13	OT
Replacing eWIC Cards	FDS 04.7	11/14	OT

VI. Participant Rights and Responsibilities
Participant Rights and Responsibilities	PRR 01.0	8/16	OT
Proxy	PRR 02.0	11/15	OT
Caretaker	PRR 02.1	8/16	OT
Confidentiality and Release of Information	PRR 03.0	11/18	OT
Complaints and Civil Rights Procedures	PRR 04.1	5/18	OT
Fair Hearings	PRR 06.0	8/13	OT

VII. Administration
Caseload Assignment and Funding Allocations	ADM 01.0	8/13	OT
Interruption of Benefits	ADM 02.0	8/13	OT
Waiting Lists	ADM 02.1	8/13	OT
Funding Principles	ADM 03.0	8/13	OT
Fiscal Year Conversion	ADM 03.3	8/13	OT
Shared Purchases / Expenses	ADM 03.4	11/18	OT
Allowable WIC Expenditures and Allocations	ADM 03.5	8/13	OT
Unallowable Spending Costs	ADM 03.6	8/13	OT
Time & Effort Reporting	ADM 03.7	7/17	OT
Capital Expend., Eqpmnt. Cmptr. Purchase Requirements	ADM 03.8	6/18	OT
Cost Allocation for Shared Expenses	ADM 03.9	11/18	OT
Fiscal Record Keeping: General Guidelines	ADM 03.10	8/13	OT
CARDINAL State Accounting System	ADM 03.11	4/17	OT
WIC Services Plan (WSP) & Memorandum of Agreement	ADM 04.0.1	8/13	OT
Participant Surveys	ADM 04.0.2	8/13	NT
State Technical Assistance Review (STAR)	ADM 04.1	2/18	OT
Audits/Reviews	ADM 04.2	6/18	OT
Program Abuse and Sanctions	ADM 05.0	8/13	OT
Dual Participation	ADM 05.1	8/13	OT
Collection of Improp. Issued Benefits / Claims Against Participants	ADM 05.2	8/13	OT
Separation of Duties	ADM 06.0	7/20	OT
Conflict of Interest	ADM 06.1	8/13	OT
Program Accessibility	ADM 08.0	4/17	OT
Marketing and Media Outreach	ADM 08.1	3/17	OT
National Voter Registration Act	ADM 09.0	8/13	OT
Emergency Procedures	ADM 10.0	8/13	OT
Record Retention	ADM 11.0	3/18	OT
Clinic Closure – Relocation	ADM 11.1	8/16	OT
Full Disclosure	ADM 12.0	8/13	OT
System Outage	ADM 13.0	11/15	OT
VIII. Vendor Management
Inadequate Participant Access Assessment	VEN 01.0	8/13	VT
Retail Store Contact with Local Agencies	VEN 03.0	4/17	VT
Solicitation Issues	VEN 04.0	8/13	VT
Solicitation of Gifts and Retail Stores	VEN 04.1	8/13	VT
WIC Shopping Options	VEN 05.0	8/13	VT
WIC Approved Shelf Labels	VEN 06.0	8/13	VT
Retailer Complaint Handling	VEN 07.0	8/13	VT
WIC Retailer Training	VEN 08.0	8/13	VT
Personal Identification Number (PIN) and eWIC Card	VEN 09.0	06/17	VT

IX. Forms
Release of Information Form	WIC-309	12/22	OT
Release of Information Form (Spanish)	WIC-309-S	12/22	OT
Participant Rights and Responsibilities	WIC-310	12/22	OT
Participant Rights and Responsibilities (Spanish)	WIC-310-S	12/22	OT
Caretaker Designation Form	WIC-311	6/16	OT
Caretaker Designation Form (Spanish)	WIC-311-S	6/16	OT
Proxy Designation Form	WIC-314A	6/16	OT
Proxy Designation Form (Spanish)	WIC-314A-S	6/16	OT
Proxy Signature Form	WIC-314B	6/16	OT
Proxy Signature Form (Spanish)	WIC-314B-S	6/16	OT
Letter of Ineligibility	WIC-315	6/16	OT
Letter of Ineligibility (Spanish)	WIC-315-S	6/16	OT
Delayed Benefits Signature Authorization	WIC-318	8/17	NT
Delayed Benefits Signature Authorization (Spanish)	WIC-318-S	8/17	NT
Notification of Alternative Hours Form	WIC-340	8/13	OT
Complaint Against Store Form	WIC-345A	2/22	VT
Complaint Against Store Form (Spanish)	WIC-345A-S	2/22	VT
Complaint Against Participant or Local Agency Form	WIC-345B	6/16	OT
WIC Program Complaint Form (Spanish)	WIC-345B-S	6/16	OT
WIC Civil Rights Impact Analysis Form	WIC-351	4/16	OT
Civil Rights Training Log	WIC-375	8/13	OT
Affidavit	WIC-383	6/16	OT
Affidavit (Spanish)	WIC-383-S	6/16	OT
Donation of WIC Formula Acknowledgement Form	WIC-388	7/20	NT
Disqualification Letter for Program Abuse	WIC-393	6/16	OT
Disqualification Letter for Program Abuse (Spanish)	WIC-393-S	6/16	OT
Request for Special Food Package	WIC-395	6/21	NT
Separation of Duties Log	WIC-400	8/13	OT
eWIC Card Stock and Card Holder Inventory Log	WIC-402	8/13	OT
Local Agency Returned Formula and Nutritional Inventory Form	WIC-404	7/20	NT
Local Agency Formula and Nutritional Donation Log	WIC-405	7/20	NT
Local Agency Formula and Nutritional Disposal Log	WIC-406	7/20	NT
Inadequate Participant Access Assessment (IPA) Form	WIC-410	8/13	VT
Racial / Ethnic Data Collection Form	WIC-415	6/05	OT
Racial / Ethnic Data Collection Form (Spanish)	WIC-415-S	6/05	OT
WIC System Outage Form for Eligibility	Crossroads-01	8/13	OT
WIC System Outage Form for Nutrition	Crossroads-02	8/13	NT
WIC Local Agency Personnel Contact Change	Email-01	10/13	OT
Policy Review Request Form	MISC-001	8/13	OT

X. Appendices
Combat Pay	Appendix 1	8/13	OT
Medicaid Financial Eligibility	Appendix 2	7/18	OT
Regulations Governing Dietitians and Nutritionists	Appendix 3	8/13	NT
Certification of Records Destruction Form	Appendix 6	1/13	OT
STAR Monitoring Tool	Appendix 7	3/19	OT
Formula Manufacturers	Appendix 8	8/13	NT
Food Standards	Appendix 11	6/18	NT
Allowable Food Application Form	Appendix 12	8/13	NT
Request for New Food Item Consideration	Appendix 14	8/13	NT
Determine Nutrition Risk – Anthropometric	Appendix 15	8/13	NT
Breastfeeding Peer Counselor Standards of Practice	Appendix 16	8/13	NT
Breastfeeding Peer Counselor Scope of Practice	Appendix 17	1/25	NT
Overdue Breast Pump Letter	Appendix 18	3/22	NT
Regulations Regarding Breastfeeding	Appendix 19	3/22	NT
Scope of Practice for Designated Breastfeeding Expert	Appendix 20	1/25	NT

XI. Glossary	Glossary	02/18	OT
XII. Emergency Procedures
Remote WIC Services		11/22	NT
Coordination Communication	EP 1.0	4/25	OT
Continuation of Benefits_Remote Services	EP 2.0	4/25	OT
Benefit Issuance and Redemption	EP 3.0	4/25	OT
Vendor Management	EP 4.0	4/25	VT
Nutrition Services	EP 5.0	4/25	NT

Last Updated: April 16, 2025

Table of Contents

I. Intake

II. Certification

III. Nutrition Education

IV. Breastfeeding

V. Food Delivery Services

VI. Participant Rights and Responsibilities

VII. Administration

VIII. Vendor Management

IX. Forms

X. Appendices

XI.

XII. Emergency Procedures