GEORGIA WIC PROGRAM PROCEDURES MANUAL CT WIC Certification Form Policy No. CT- 840.03 Effective date: October 1, 2018
No. of Pages: 2 Revised February 2019
Page 1 of 2
Policy State WIC certification data for each applicant/participant will be recorded on the certification form provided by the State agency or entered in the District’s computer system. Paper certification forms may be used to certify applicants only when the computer system is inoperable, for a hospital, or home certification. Information gathered on a paper certification form must be entered in the electronic record within twenty-four hours of certification or of the system being operable. All eligibility data for each person certified for WIC shall be recorded on the appropriate forms. The forms shall be maintained on file in each participant's or family’s health record.
Purpose To document the eligibility of each participant. To increase participant access to services when the approved computer system is inoperable or inaccessible.
Procedures I. Print a copy of the certification form for each certification or mid-year assessment completed in the district’s computer system.
A. Collect required signatures and initials.
B. File the form in the participants record or scan the form into the participant’s record.
II. Reference Prenatal Certification Form, Breastfeeding Certification Form, Non- Breastfeeding Certification Form, Infant Certification Form, and Child Certification Form.
III. The Local Agency (LA) shall determine where the forms shall be maintained in the record which should include, but not limited to: 1. Certification Form; 2. Signed copy of Rights and Responsibilities 3. Income Questionnaire Form; and 4. Required proof documentation 5. Diet History Questionnaire 6. Appropriate Growth Charts 7. Physical presence waiver form, if applicable
GEORGIA WIC PROGRAM PROCEDURES MANUAL CT WIC Certification Form Policy No. CT- 840.03 Effective date: October 1, 2018
No. of Pages: 2 Revised February 2019
Page 2 of 2
IV. A supply of paper certification forms must be kept on hand for each WIC category for emergency purposes.
Authority 7 C.F.R. § 246.7(i) Georgia WIC Program Policy Definitions/Supporting Information (None)