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State Plan Checklist - CERTIFICATION, ELIGIBILITY & COORDINATION OF SERVICES 8/14/2026 Page 2

A. Eligibility, Determination, and Documentation

1. Application Process

a. The State agency requires all local agencies to use a standardized application process for all persons applying for the WIC Program Yes No

b. The State agency shares on Statewide or on at local agency (check one), a common income application or certification form with (check all that apply): [X] No other benefit programs [X] Other reduced-price health care program(s) [ ] Maternal and Child Health (MCH) [ ] SNAP [ ] TANF [ ] Medicaid [X] Other Specify: No other benefit programs ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation)

2. Residency, Identity and Physical Presence Requirements

a. The State agency requires documentation of residency [X] Yes [ ] No other benefit programs b. The State agency has reciprocal agreements concerning residency with other State agencies Yes No

If yes, describe any reciprocal agreements: on This is not applicable for my state agency