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Attachment #4, 9.01 2 of 9

a) Custody papers b) VOC for transfers into West Virginia (WV) c) Photo Release Form d) Prescription Formula Form (WIC-53) e) Sanction Letters

Are VOC cards accepted if certification period is valid, or previous clinic contacted to verify that a valid certification period is in effect?

Is Voter Registration offered at each certification, sub-certification appointment and when an address change is reported? Is the proper form completed for documentation?

Is every effort made to coordinate appointments within a family if the family has multiple WIC participants?

Is EBT card use and responsibility explained to parent/guardian or caretaker prior to card issuance?

Is each participant provided a current list of WIC vendors and a current food list?

Are women certified without proof of pregnancy and given 60 days to provide documentation of pregnancy, if pregnancy cannot be visually verified?

Civil Rights

Clerk and/or supervisor: describe the procedure for handling a civil rights complaint.

Staff demonstrate ability to locate approved Civil Rights Complaint Form on WIC website.