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data collection ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy 3.10 and ROSIE, Wisconsin WIC Program Risk Criteria

C. Health Care Agreements, Referrals, and Coordination 1. State Agency Referral Agreements and Coordination of Services a. The State agency has written formal agreements that permit the sharing of participant information with the following programs/providers (indicate whether information is shared manually (M) or through ADP (A) by placing either an M or A in front of the appropriate service): Click or tap here to enter text. SNAP Click or tap here to enter text. Rural/migrant health centers Click or tap here to enter text. TANF Click or tap here to enter text. Hospitals Click or tap here to enter text. Medicaid Click or tap here to enter text. Childhood immunization Click or tap here to enter text. SSI A Immunization registries Click or tap here to enter text. EPSDT Click or tap here to enter text. Well-child programs Click or tap here to enter text. MCH programs Click or tap here to enter text. Child protective services Click or tap here to enter text. Family planning Click or tap here to enter text. IHS facilities Click or tap here to enter text. Private physicians Click or tap here to enter text. Children with special health care needs program(s) Click or tap here to enter text.Other (specify): A Lead Program, M Fit Families, M Mortality Review b. Formal agreements for coordination of services include: ☒ Responsibilities of each party ☐ Assurance that information is used only for program eligibility and/or outreach ☐ Assurance that information will remain confidential and not be shared with a third party c. The State agency requires local agencies to coordinate services with, and/or develop referral systems for, the following (check all that apply):

☒ SNAP ☐ Children with special health care needs ☐TANF ☐ Schools ☐ SSI ☐ Expanded Food and Nutrition Education Program