641.1 Policy 641 Documentation Requirements for Certification in the Absence of a Data System September 30, 2019 POLICY Local program staff shall complete the required certification forms in situations where the data system is unavailable at the time of a certification. These situations include offsite visits, non-computer satellite clinics, and disaster recovery. Local program staff must enter the data into the data system within two working days of the certification. PURPOSE To ensure that data collected on paper certification forms is properly collected and entered into the data system to complete the certification process in a timely manner. RELEVANT REGULATIONS 7 CFR §246.7—Certification of participants OREGON WIC PPM REFERENCES

♦ 400—Local Program Overview: Responsibilities and Communications ♦ 600—Certification Introduction and Overview ♦ 635—Participant Notification: Eligibility and Rights and Responsibilities ♦ 636— Participant Notification: Ineligibility and Termination from WIC ♦ 640—Documentation Requirements for Certification DEFINITIONS Required information: Information that must be collected for WIC applicants to be enrolled on the WIC program. Optional information: Information that may be collected for WIC applicants but is not required for enrollment. Initial certification: The first certification for an individual who has never participated in WIC or has not participated in WIC for 12 months or more. Subsequent certification (recertification): Any certification after the initial certification. Disaster recovery: The continuation of WIC services in the event of a disaster. Non-computer satellite clinics: A non-permanent clinic that certifies participants without access to a data system. Offsite visits: A certification that occurs outside of the WIC clinic setting without access to the data system.

Documentation Requirements for Certification in the Absence of a Data System, Continued 641.2 PROCEDURE Initial/subsequent certifications 1.0 For any participant enrolled at an initial or subsequent certification in a situation when the data system is unavailable, local agency staff must complete the required certification forms listed in the table below. These situations may include offsite visits such as those that occur in the home, non-computer satellite clinics, and disaster recovery situations. Refer to 640—Documentation Requirements for Certification.

Required certification forms

These forms are available online for downloading and printing from the WIC website: https://www.oregon.gov/OHA/PH/HEALTHYPEOPLEFAMILIES/WIC/Pages/cli nicforms.aspx Form #

Form Title 57- Lang. Available electronically only 615 ENGL Certification Data Entry Document: Women, Infants, Children 617 ENGL Health Questionnaire: Infants/Children 617 SPAN Cuestionario de Salud: Infantes y Niños 618 ENGL Health Questionnaire: Pregnant Women 618 SPAN Cuestionario de Salud para Mujeres Embarazadas 619 ENGL Health Questionnaire: Postpartum Women 619 SPAN Cuestionario de Salud para Mujeres que Han dado a Luz 622 ENGL Your Baby’s Diet Questions 622 SPAN Preguntas sobre la dieta de su Bebé 624 ENGL Your Child’s Diet Questions 624 SPAN Preguntas sobre la dieta de su Niños 626 ENGL Your Diet Questions 626 SPAN Preguntas sobre su Dieta Available in hard copy from Shopify or electronically 629

Participant Signature Form (Available in English, Spanish, Russian, Vietnamese, Chinese, Somali, Arabic) 633 ENGL/ SPAN No Proof Form for Special Situation and Income Averaging 636 ENGL Medical Documentation form PDF

Participant rights and responsibilities

The paper “Participant Signature Form” must be completed at every initial or subsequent certification regardless of data system availability.

Documentation Requirements for Certification in the Absence of a Data System, Continued 641.3 1.2.1. Refer to 635—Participant Notification: Eligibility and Rights & Responsibilities for guidelines on distribution of the “My Rights and Responsibilities” handout (form 57-630) and completion of the “Participant Signature Form.” Required information

Complete all fields on the required paper certification forms in order to subsequently complete the mandatory fields in the data system. Time frame for data entry

Enter information into the data system within two working days of certifying an individual using paper certification forms. Contact the state WIC program if the data system is unavailable within that timeframe. In emergency situations, another local agency or the state WIC office can assist with data entry and benefit issuance. Process for data entry 1.4.1. Local programs must ensure that a process is in place for data entry of paper certification forms within the required two working days. CPA review 1.4.2. After the required data elements from the health questionnaire have been entered into the data system, a Certified Professional Authority (CPA) must review the health history questionnaire screen and check the “CPA reviewed” box. Benefit Issuance 1.4.3. Benefits can only be issued after all required certification documentation has been entered in the data system. Disposal of paper certification forms

Once all the required data elements from the paper certification forms are entered into the data system, local program staff must destroy the forms following the appropriate method for destruction of confidential and sensitive documents.

Locally produced paper certification forms 2.0 If the local program develops its own paper certification forms, the forms must meet the requirements in this policy. To ensure that all required data is collected, local programs must get approval from the state WIC program prior to using the locally produced forms. See 400—Local Program Overview: Responsibilities and Communications.

Whenever state forms are revised, local programs must revise any similar form that they have developed within 60 days of receipt of the revised state form and submit the revised form(s) to the state WIC office for approval before use. Ineligibility 3.0 Complete a “Notice of WIC Ineligibility” (form 57-607) or “Change in Your WIC Benefits” (form 57-608) if an applicant or a participant is found ineligible while

Documentation Requirements for Certification in the Absence of a Data System, Continued 641.4 completing a certification in the absence of the data system. Document ineligibility in the data system within two working days. See 636— Participant Notification: Ineligibility and Termination from WIC

POLICY HISTORY Date * Major Revision, Minor revision May 25, 2015 Revised Sept. 30, 2019 Minor revision

The date located at the top of the policy is the implementation date unless an “effective date” is noted on the policy. Policies will become compliance findings 6 months from the implementation date. Release notes can be found in the corresponding document on the Policy and Procedure Manual page. *Major Revisions: Significant content changes made to policy. Minor Revisions: Minor edits, grammatical updates, clarifications, and/or formatting changes have occurred. Date of Origin: Date policy was initially released

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