Page 7
nutrition risk and are able to present at least two of the three required documents (identification, residency, and income) during a certification appointment is completed and food instruments are provided. However, if applicant does not provide documentation within 30 days, certification expires, and a new eligibility determination must be conducted. ☐Other (specify): N/A. d. The State agency requires ☒State-wide, or ☐at local agency discretion (check one), the verification of applicant income information, if determined necessary ☒No ☐Yes (check all sources required, as appropriate): ☐Employer ☐Public assistance offices ☐State employment offices (wage match, unemployment) ☐Social Security Administration ☐School districts/offices ☐Collateral contacts ☐Other (specify): N/A. e. The State agency has specific policies that define actions to be taken at a mid-certification appointment if a participant’s income eligibility changes. ☒Yes; Please specify: Policy and Procedure 2.06 Income Eligibility Requirements. ☐No f. The State agency allows documentation of alternate income procedures for Indian or Indian Health Service (IHS) operated local agencies. ☐Yes ☐No ☒Not Applicable g. The State agency has a specific policy that addresses income from benefits provided by a State-administered programs. ☒Yes ☐No h. The State agency has a specific policy to ensure that certain types of income, such as combat pay or Family Subsistence Supplemental Allowance (FSSA) payments for households that include service members, are excluded from consideration in the WIC income eligibility determination, as provided by law and regulation. ☒Yes ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 and 2.06 Attachment #3 Income Eligibility Requirements 7