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I. FOOD DELIVERY CHECKLIST 3. Home food delivery vendors include: ☐ Dairies ☐ Private delivery service doing WIC business only ☒Private delivery service ☐ Infant formula providers Hospitals ☐ Other (specify): Click or tap here to enter text.

4. Participants who receive home food delivery: ☐ Are notified in writing of the types and quantities of food they will receive ☐ Indicate by authorized signature on FI, receipt, or signature device that supplemental foods were received ☒ Are delivered only a one-month supply of supplemental foods per delivery ☒ Other (specify): Participants verify benefits being deducted during online checkout. 5. Supplemental foods may be delivered: ☐ Only to the participant ☐ To the proxy ☐ To any adult at home during time of delivery ☒ To anyone at home during time of delivery ☐ Other (specify): Click or tap here to enter text.

6. Documentation:

a. The forms verifying delivery are reconciled against vendor invoices: ☐ Weekly ☐ Monthly ☒ Other (specify): Payment files are matched back to issuance. If participant indicates formula is missing, delivery method is researched with CAP Formula Warehouse and future orders must be shipped to the clinic..

b. Signatures of participants who sign the receipt are compared to signatures on file: ☐Yes

☒No

7. Please attach a list of the names of contractors/providers that the State agency works with to provide Home Delivery services: CAP of Lancaster, Umoja Supply.

ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix III. DIRECT DISTRIBUTION FOOD DELIVERY SYSTEMS

☐ Does not apply (proceed to next section)

1. The State agency uses direct distribution food delivery systems to:

4 February 2024