CERTIFICATION WPPM #260-40 Subject: Information Provided by the Local Agency at Certification Item: WIC Participant Rights and Responsibilities

Revised California WIC Policy and Procedure Manual Page 1 of 2 April 28, 2025 PURPOSE: To ensure that family representative/caretakers are informed of their rights and responsibilities for participation in the WIC program. POLICY: I. Local agency (LA) staff must ensure that the family representative/caretaker reads the Know Your Rights and Responsibilities (R&R) form, watches the R&R section of the Welcome to WIC video, or has, the approved summary of the R&R read by LA staff, understands and signs at initial certification, recertification, and when transferring from out-of-state with a verification of certification (VOC). PROCEDURES: I. Once eligibility has been determined at initial certification or recertification, LA staff must do the following: A. Ensure that the family representative/caretaker reads the R&R form, watches the R&R section of the Welcome to WIC video, or has the approved summary of the R&R read by LA staff. 1. When the R&R is read by the family representative/caretaker or the video is watched, LA staff must: a. Verify that the R&R was read or the video was watched. b. Read all of the information in the signature box to the family representative/caretaker. c. Ensure understanding by asking if there are any questions and provide answers if necessary. d. Give a copy of the R&R form to the family representative/caretaker, if requested. 2. When the R&R is not read by the family representative/caretaker, LA staff must: a. Offer more time to the participant to read the R&R or to watch the video. If not, LA staff must read the approved summary of the R&R to the participant. b. Read all of the information in the signature box to the family representative/caretaker. c. Ensure understanding by asking if there are any questions and provide answers if necessary. d. Give a copy of the R&R form, if requested. B. Have the family representative/caretaker electronically sign R&R in WIC WISE to certify they understand their rights and responsibilities.

CERTIFICATION WPPM #260-40 Subject: Information Provided by the Local Agency at Certification Item: WIC Participant Rights and Responsibilities

Revised April 28, 2025 California WIC Policy and Procedure Manual Page 2 of 2 C. The electronic signature is retained in WIC WISE. D. When electronic signature cannot be obtained or LA staff cannot document verbal confirmation to write in the e-signature box on the family representative/caretaker’s behalf, a signed R&R must be scanned into WIC WISE. Refer to WPPM 1000-140. II. LA staff cannot require the family representative/caretaker to sign any LA-created agreements or contracts as a condition of program participation, in addition to the R&R form, unless approved by CDPH/WIC. AUTHORITY: 7 C.F.R. §246.7(i)(10) 7 C.F.R. §246.7(j) 22 C.C.R. §40681 22 C.C.R. §40813 RESOURCE: R&R Summary Job Aid (English) R&R Summary Job Aid (Spanish) CROSS REFERENCE: WPPM 1000-140 WIC WISE Forms Job Aid