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State Plan Checklist - CERTIFICATION, ELIGIBILITY & COORDINATION OF SERVICES 8/14/2026 Page 15

If yes, attach mandated forms (or MIS screen shots) or specify location in the procedure manual and reference below. on This is not applicable for my state agency

If no, the State agency assures quality of nutrition assessment by: on This is not applicable for my state agency [ ] Requiring local agencies to submit forms for approval [ ] Annually monitoring the locally developed forms during local agency review [ ] Other Dietary assessment is based on professionally recognized guidelines (e. g. , Dietary Guidelines for Americans, My Plate Food Guide, American Academy of Pediatrics) [X ] Yes [ ] No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (cite):

AL WIC Procedure Manual Ch. 4 Nutrition Assessment

2. Documentation

a. The State agency requires documentation in the applicant s case file for all nutrition risk criteria used to establish WIC eligibility (check one) (as described in FNS Policy Memorandum 2008-4, WIC Nutrition Services Documentation):

Yes, supported by a written "exceptions" policy (e.g., policies to direct clinic staff in situations in which documentation is unavailable) Yes, with CPA discretion when to waive documentation requirement (no written policy) No

b. As a matter of policy, the State agency requires the documentation of nutritional risk criteria on a participant's certification form in the following manner: [X] All identified risk criteria are recorded [ ] A set number of criteria is recorded [ ] Local agency personnel decide how many and which criteria are recorded Attachment - Crossroads MIS Nutrition Assessment screen shots