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State Plan Checklist - FOOD DELIVERY 8/14/2026 Page 3

A. GENERAL ADMINISTRATION

1. Which of the following food delivery systems does your State agency operate? Be sure to consider how the State agency provides specialty formula to participants. [ ] Home Food Delivery (please fill out section B) [ ] Direct Distribution Food Delivery (please fill out section C) [X] Retail Food Delivery (please fill out sections D, E, and F) ADDITIONAL DETAIL Food Delivery Appendix and/or Procedure Manual (citation):

B. HOME FOOD DELIVERY SYSTEMS

Does not apply (proceed to the next section)

1. The State agency uses home food delivery systems to: [ ] Provide all WIC program foods [ ] Reach select remote / rural participants [ ] Reach select participants with mobility or transportation concerns [ ] Provide specialty infant formula and/or medical foods [ ] Other

2. Home food deliveries take place: Monthly Bi-monthly Every three month Other

3. Home food delivery vendors include: [ ] Dairies [ ] Private delivery service doing WIC business only [ ] Private delivery service [ ] Infant formula providers [ ] Hospitals '