West Virginia WIC Policy & Procedure 2.10

Effective Date: 4/15/21 2.10 Notification of Participant Rights and Responsibilities

1 of 2 POLICY:

The applicant and participant or their parent(s)/guardian(s) or caretakers will be informed of their Program rights and responsibilities during each certification appointment and will confirm by signing the Participant Agreement Form (WIC-05).

PROCEDURE:

A. Notification of Participant Rights and Responsibilities (Participant Agreement Form)

1. At certification appointments, each Program participant, parent/guardian or caretaker must read, or have read to him or her, the Participant Agreement Form (WIC-05), which outlines their Program rights and responsibilities.

2. WIC personnel will verbally inform the Program applicant/participant, parent/guardian or caretaker of the following prior to signing the Participant Agreement Form (WIC-05) during each certification:

a. That dual participation is illegal, and they may only use one (1) WIC clinic at a time;

b. Eligibility and participation standards in the WIC Program are the same for everyone, regardless of race, color, national origin, age, handicap or sex;

c. They may appeal any decision made by the Local Agency regarding Program eligibility (see Policy 1.07 Fair Hearing Policy for Applicants and Participants);

i. Persons found ineligible for the Program during a certification visit shall be advised in writing of the ineligibility, of the reasons for the ineligibility, and of the right to a fair hearing. The reasons for the ineligibility will be documented on the Crossroads Notice of Ineligibility.

ii. A copy of the Crossroads generated Notice of Ineligibility will be scanned into the applicant’s chart (see Policy 2.09 Notification of Ineligibility).

d. That they must use their eWIC Benefit Card and eWIC benefits correctly to avoid losing WIC benefits.

i. At minimum during the initial certification visit, each participant or parent/guardian will receive an explanation of how to use eWIC benefits. ii. Selling, trading, or giving away eWIC benefits or food purchased with eWIC benefits will result in disqualification from the WIC Program.

West Virginia WIC Policy & Procedure 2.10

Effective Date: 4/15/21 2.10 Notification of Participant Rights and Responsibilities

2 of 2 3. The participant, parent/guardian or caretaker will sign the Participant Agreement Form (WIC-05) electronically, in Crossroads, to document that they have been informed of their Program rights and responsibilities and that all information they have provided for eligibility determination is correct.

a. If the Participant Agreement Form (WIC-05) is unable to be electronically signed, the participant, parent/guardian or caretaker will sign a paper copy of the form. This will be scanned into the Income Information Screen in Crossroads.

b. The participant, parent/guardian or caretaker will sign the Participant Agreement Form (WIC-05) at every certification visit, including the initial certification and all subsequent certifications.

i. The Participant Agreement Form (WIC-05) will be signed by the legal guardian when there is a custody change.

ii. The Participant Agreement Form (WIC-05) will be signed by the participant or parent/guardian when completing a transfer of certification into West Virginia (VOC).

B. Referral to Health and Human Resource Programs

1. WIC personnel will assess the participant’s need for Health and Human Resource Programs, advising the participant, parent/guardian or caretaker of the types of services available, where they are located, how they may be obtained and why they may be useful.

2. Programs include, but are not limited to, Medicaid, Right From the Start, Head Start/Early Head Start, and information on immunization.

a. Referrals will be documented in the participant’s record in Crossroads.

REFERENCES:

1. WIC Regulations 246.7 Certification of Participants 2. West Virginia WIC Participant Agreement, WIC-05 3. Nutrition Service Standards, Standard 10, Program Coordination and Referrals