GEORGIA WIC PROGRAM POLICY AND PROCEDURES MANUAL CT Notice of Disclosure Policy No. CT-800.16 Effective date: October 1, 2016
No. of pages: 2
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Revised June 2018 Policy Local agencies (LA) must inform applicants/participants and the caregivers of minor WIC applicants/participants of the potential that their information may be shared with other public organizations that administer programs for the purpose of determining eligibility for the other services. LA must explain the Notice of Disclosure (located on the certification form) to participant/alternate-proxy/caregivers and ask them to indicate whether he/she consents or declines to the release of their information at each certification. Participant/alternate- proxy/caregivers must be informed that their decision to share or not to share their information shall not affect their ability to receive WIC services.
Purpose
To ensure compliance with the federal regulations that govern the disclosure of confidential applicant and participant information that is collected by the local agencies that administer the Georgia WIC Program in partnership with the State Agency.
Procedures
I. At each certification the local agency staff must:
1. Allow the applicant/participant to read (or have read to them) the Notice of Disclosure statement.
2. Inform applicants/participants that a decision to not allow their information to be shared with other public organizations will not impact their eligibility to receive WIC benefits and services.
3. Request the applicant/participant or parent/caregiver/guardian/spouse or alternate- proxy parent to initial either the “I Agree” or the “I Do Not Agree” statement on the WIC Assessment Certification Form below the Notice of Disclosure statement or in Georgia Gateway.
II. Document the applicant/participant decision within the Georgia Gateway System or the WIC record by completing the Yes/No answer.
GEORGIA WIC PROGRAM POLICY AND PROCEDURES MANUAL CT Notice of Disclosure Policy No. CT-800.16 Effective date: October 1, 2016
No. of pages: 2
Page 2 of 2
Revised June 2018
Authority 7 CFR § 246.7(b) 7 CFR § 246.7(d)(2) and (4) 7 CFR § 246.7(h)(3)(i) Definitions/Supporting Information (None)