CERTIFICATION WPPM #280-30 Subject: Ineligibility and Disqualification Item: Notices of Action

Revised September 20, 2023 California WIC Policy and Procedure Manual Page 1 of 2

PURPOSE: To assist local agency (LA) staff in determining which Notice of Action is appropriate to use. POLICY: I. LA staff must provide a Notice of Action at Initial Certification and Recertification (CDPH 4134) to each applicant/family representative/caretaker when they are determined ineligible for the WIC Program at: A. Initial certification. B. Recertification. C. After the 30/60 day short certification when the required documentation of income, residency, ID, proof of pregnancy, or infant presence is not provided. II. LA staff must provide a Notice of Action During WIC Certification Period (CDPH 4304) to each participant/family representative/caretaker when they are determined ineligible during a certification period due to: A. Income changes during certification period and family is over income. B. Breastfeeding participant who completely stops breastfeeding after 6 months post-partum. C. Moving out of California. D. Insufficient program funds and not serving lower priority nutritional need or not meeting nutritional need criteria. III. LA staff must provide a Notice of WIC Certification Expiration (CDPH 4147) when a participant’s certification period expires based on their current category: A. Child turning five years old. B. Non-breastfeeding postpartum participant whose infant will turn 6 months old. C. Breastfeeding postpartum participant whose infant will turn 1 year old. D. Postpartum participant whose pregnancy ended 6 months ago. PROCEDURES: I. CDPH 4134 Notice of Action at Initial Certification and Recertification A. The 4134 notifies the family representative/caretaker of the reason why they are not eligible for program benefits. The date of ineligibility is the date the determination is made.

CERTIFICATION WPPM #280-30 Subject: Ineligibility and Disqualification Item: Notices of Action

Revised September 20, 2023 California WIC Policy and Procedure Manual Page 2 of 2

B. LA staff must: 1. Explain why the applicant is not eligible for participation in the WIC Program. 2. Have the applicant/family representative/caretaker sign the signature pad. 3. Provide a copy of the form to the applicant/family representative/caretaker. 4. Not issue benefits. II. CDPH 4304 Notice of Action During WIC Certification Period A. The CDPH 4304 notifies the family representative/caretaker of the reason why the participant is no longer eligible for program benefits. The termination is effective 15 calendar days after the date of the ineligibility determination. B. LA staff must: 1. Terminate the participant. Extend the termination date 15 calendar days. 2. Have the family representative/caretaker sign the signature pad. 3. Provide a copy of the form to the family representative/caretaker. 4. Not issue benefits. III. CDPH 4147 Notice of WIC Certification Expiration A. The CDPH 4147 notifies the family representative/caretaker that the certification period of a participant will end and they will no longer be eligible for program benefits. B. LA staff must: 1. Notify the family representative/caretaker at the last WIC contact prior to the certification end date that the certification period will end. 2. Provide a copy of the form to the family representative/caretaker. 3. Issue benefits as appropriate. AUTHORITY: 7 CFR §246.7(h) and (j) 22 CCR §40679 22 CCR §40681 22 CCR §40703(c) and (e) 22 CCR §40813