Division of Community Nutrition

Subject: Participant’s Rights and Responsibilities Policy: PRR 01.0 Reference: CFR §246.7 Effective: August 1, 2025 Supersedes: August 15, 2016

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I. Policy:

The participant rights and responsibilities form shall be signed and reviewed in Crossroads during the initial and subsequent certification visits by the participant, parent, legal guardian, or caretaker. The proxy cannot sign as a replacement. The information shall be reviewed with applicants in the appropriate language.

II. Procedure(s):

A. At initial and subsequent certifications local agency personnel shall review with the participant, parent, legal guardian, or caretaker the contents of the form. The participant, parent, legal guardian, or caretaker shall sign acknowledgement of understanding in Crossroads. A copy of the form shall be given to the parent, legal guardian, or caretaker.

B. Local agency personnel shall review the form in the appropriate language and ensure that participants, including those that are visually or hearing impaired understand the form.

C. A WIC Participant Handbook shall be given to the participant, parent / legal guardian or caretaker to further explain the rights and responsibilities.

D. An “X” signature is allowed for persons unable to sign their name. Local agency personnel shall write “witnessed by” and their initials beside the “X.”

E. If the Crossroads system is not accessible, the Participant Rights and Responsibilities (WIC-310) form in the WIC Policy & Procedure Manual shall be used. Signed forms shall be scanned into Crossroads when the system is accessible. A copy of the form shall be given to the participant, parent, legal guardian, or caretaker.