Connecticut WIC Program Manual

WIC 200-22 SECTION: Certification

SUBJECT: Disposition of Certification files Federal Regulations: §246.25(a) (1-2) POLICY Participant files will be maintained in the CT-WIC system per Federal Regulations for a period of three years following the date of submission of the final expenditure report for the period to which the report pertains for audit purposes. The requirements for local agencies to maintain in each WIC participant file for all active and terminated “inactive” participants and ineligible applicants are detailed below.

Active CT-WIC participant files must include the following scanned forms:

• WIC Applicant/Participant Authorization Form • Request for Caretaker form • Certification form(s) (received from a third party) • Laboratory Results (if not recorded on the certification form) •

These forms are required when applicable:

• Medical Documentation form • Prescriptions for Special formula • Written confirmation of Verbal Orders received for special formula, or medical conditions • Request for Fair Hearing Notice • Copy of Verification of Certification from other State agency • Self-Declaration Form • Verification Form

Additional forms (fillable from CT-WIC) that must be maintained in the CT-WIC file include:

• WIC Participant Rights and Responsibilities Form

The file may also include the following:

• Any forms required by the local agency • Verification of ongoing healthcare (if applicable)

Terminated “inactive” participant file (Participants who are no longer participating, who have been terminated or disqualified):

For previously active participants this includes all information listed above.

CT-WIC generated for

• Notice of Participant Action Form

Ineligible applicant files* (Applicants who upon visiting the local agency are determined ineligible for WIC benefits on the basis of category, residency, income or nutrition risk):

Files must include the following:

• Completed WIC certification form, received by third party • Copy of completed, dated, and signed Notice of Participant Action form

*In most cases individuals that present to the WIC local agency and are determined to be ineligible based on category, residency or income will not have generated an active CT-WIC file, therefore, a signed, hardcopy of the Notice of Participant Action (NOPA) will be required to be maintained in either the WIC daily file or a specific WIC ineligible file. For those individuals that meet the category, residency or income requirements, but do not have a nutritional risk factor (extremely rare) the signed NOPA will be maintained in their CT-WIC file.

WIC local agencies are not required to keep the above documentation or to mail a completed Notice of Participant Action form to applicants whose ineligibility (based on report of income based on household size) was determined over the phone. However applicants inquiring about the Program over the phone, should be advised to call back or come in to the WIC agency in person to re-apply if their situation changes.