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State Plan Checklist - MANAGEMENT INFORMATION SYSTEM 8/14/2026 Page 10

[X] Nutrition Risk(s) Present at Certification. Up to 10 highest priority nutritional risks present at the WIC Program certification. [X] Hemoglobin or Hematocrit. That value for the measure of iron status that applies to the WIC Program certification. It is assumed that the measure was collected at the time of certification or within ninety (90) days of the certification date. [X] Date of Blood Measurement. The date of the blood measurement that was used during the most recent WIC Program certification in MMDDYYYY format. [X] Weight. The participant's weight measured according to the CDC nutrition surveillance program standards [nearest one-quarter (1/4) pound]. If weight is not collected in pounds and quarter pounds, weight may be reported in grams. [X] Height. The participant's height (or length) measured according to the CDC nutrition surveillance program standards [nearest one-eighth (1/8) inch]. If height is not collected in inches and 1/8 inches, height may be reported in centimeters. [X] Date of Height and Weight Measure. The date of the height and weight measures that were used during the most recent WIC Program certification in MMDDYYYY format. [X] Currently Breastfed. Information is needed for all infant participants ages six through thirteen months, whether or not the infant is currently receiving breastmilk. [X] Ever Breastfed. Information is needed for all infant participants ages six through thirteen months, whether or not the infant was ever breastfed. [X] Length of Time Breastfed. For infants ages six through thirteen months, the number of weeks the infant received breastmilk. [X] Date Breastfeeding Data Collected. For infants ages six through thirteen months, the date on which breastfeeding status was reported in MMDDYYYY format. [X] Food Packages. The food package code(s) for the WIC food package or for all food instruments prescribed for the participant during the month.

OPTIONAL: Supplemental Data Set on This is not applicable for my state agency

State Agency IS Collects State Agency IS Plans to Collect