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(iii) The State agency policy requires that nutrition assessment intake information be collected on a State agency mandated form or Management Information System (MIS). ☒ Yes ☐ No If yes, attach mandated forms (or MIS screen shots) or specify location in the procedure manual and reference below. If no, the State agency assures quality of nutrition assessment by: ☐ Requiring local agencies to submit forms for approval ☐ Annually monitoring the locally developed forms during local agency review ☐ Other (specify): Click or tap here to enter text.

(iv) Dietary assessment is based on professionally recognized guidelines (e.g., Dietary Guidelines for Americans, My Plate Food Guide, American Academy of Pediatrics) ☒ Yes (specify): USDA’s risk criteria ☐ No (explain): Click or tap here to enter text. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (cite):

Appendix VIII.B.1.c. Nutrition Risk Criteria, Policy 3.10 Value Enhanced Nutrition Assessment

2. Documentation a. The State agency requires documentation in the applicant’s case file for all nutrition risk criteria used to establish WIC eligibility (check one) (as described in FNS Policy Memorandum #2008-4, WIC Nutrition Services Documentation): ☒ Yes, supported by a written "exceptions" policy (e.g., policies to direct clinic staff in situations in which documentation is unavailable) ☐ Yes, with CPA discretion when to waive documentation requirement (no written policy) ☐ No (explain): Click or tap here to enter text. b. As a matter of policy, the State agency requires the documentation of nutritional risk criteria on a participant's certification form in the following manner: ☒ All identified risk criteria are recorded ☐ A set number of criteria Click or tap here to enter text. is recorded (maximum number is 10 criteria) ☐ Local agency personnel decide how many and which criteria are recorded ☐ Other (specify): Click or tap here to enter text.