| Introduction |
Policy Number |
Effective Date |
SWO Team |
| WIC Policy and Procedure Manual Overview |
Overview
|
08/12/13
|
OT
|
|
I. Intake
|
| Processing Standards and Appointments |
INT 01.0
|
08/12/13
|
OT
|
| Alternative Hours |
INT 02.2
|
08/12/13
|
OT
|
| Processing Electronic Application |
INT 02.3
|
10/15/17
|
OT
|
|
II. Certification
|
| Eligibility Overview |
CRT 01.0
|
08/12/13
|
OT
|
| Certification Visit Overview |
CRT 01.1
|
08/17/16
|
OT
|
| Immunization Screening & Referral |
CRT 01.1.1
|
08/12/13
|
NT
|
| Categorical Eligibility |
CRT 02.0
|
08/12/13
|
OT
|
| Proof of Identification |
CRT 03.0
|
02/15/17
|
OT
|
| Residential Eligibility |
CRT 04.0
|
08/12/13
|
OT
|
| Certification of Homeless/Institutionalized |
CRT 04.1
|
08/12/13
|
OT
|
| Financial Eligibility |
CRT 05.0
|
08/15/16
|
OT
|
| Adjunctive Financial Eligibility |
CRT 05.1
|
03/15/19
|
OT
|
| Income Eligibility |
CRT 05.2
|
08/12/13
|
OT
|
| Proof of Income |
CRT 05.2.1
|
09/18/23
|
OT
|
| Gross Income |
CRT 05.2.2
|
08/12/13
|
OT
|
| Income Exclusions |
CRT 05.2.3
|
08/12/13
|
OT
|
| Military Proof of Financial Eligibility |
CRT 05.2.4
|
11/15/16
|
OT
|
| Migrant / Homeless Income Eligibility |
CRT 05.2.5
|
08/12/13
|
OT
|
| WIC Program Income Guidelines |
CRT 05.2.6
|
06/05/23
|
OT
|
| Nutrition Eligibility - Overview |
CRT 06.0
|
08/12/13
|
NT
|
| Determine Nutrition Risk - Anthropometric |
CRT 06.1
|
08/15/17
|
NT
|
| Determine Nutrition Risk - Hematological |
CRT 06.2
|
06/15/18
|
NT
|
| Determine Nutrition Risk – Dietary |
CRT 06.3
|
08/12/13
|
NT
|
| Determine Nutrition Risk - Other Nutr. / Medical Cond |
CRT 06.4
|
08/12/13
|
NT
|
| Table A: Virginia WIC Program Nutrition Risks |
CRT 06.5
|
08/12/13
|
NT
|
| Certification & Changes to Certification Period |
CRT 07.0
|
08/12/13
|
OT
|
| Coordination of Services and Referral Systems |
CRT 08.0
|
08/12/13
|
NT
|
| Medicaid and Social Services Referrals |
CRT 08.0.1
|
08/12/13
|
NT
|
| Drug and Substance Abuse Referrals |
CRT 08.0.2
|
08/12/13
|
NT
|
| Blood Lead Referrals |
CRT 08.0.3
|
08/12/13
|
NT
|
| Breastfeeding Referrals |
CRT 08.0.4
|
08/12/13
|
NT
|
| Ineligibility |
CRT 09.0
|
08/12/13
|
OT
|
| System Termination from the WIC Program |
CRT 09.1
|
03/15/19
|
OT
|
| Subsequent Certifications |
CRT 11.0
|
03/15/19
|
OT
|
| WIC Out-Of-State Transfer Card - Issuance |
CRT 13.0
|
05/01/16
|
OT
|
| WIC Verification of Certification Card Acceptance |
CRT 13.1.1
|
08/15/16
|
OT
|
| In-State Transfers |
CRT 13.2
|
08/12/13
|
OT
|
|
III. Nutrition Education
|
| Nutrition Education Overview |
NEd 01.0
|
08/12/13
|
NT
|
| Nutrition Education Materials |
NEd 01.1
|
08/12/13
|
NT
|
| Nutrition Education Contacts |
NEd 02.0
|
08/12/13
|
NT
|
| Nutrition Education Contact - Initial |
NEd 02.1
|
08/12/13
|
NT
|
| Nutrition Education Contact-Follow-up, Low Risk |
NEd 02.2
|
08/12/13
|
NT
|
| Nutrition Education Contact - Follow-Up, High Risk |
NEd 02.3
|
08/12/13
|
NT
|
| Nutrition Education Methods |
NEd 03.0
|
08/12/13
|
NT
|
| Nutrition Education - Individual Counseling |
NEd 03.1
|
08/12/13
|
NT
|
| Nutrition Education - Group |
NEd 03.2
|
08/12/13
|
NT
|
| Nutrition Education - Web Based |
NEd 03.3
|
08/12/13
|
NT
|
| Nutrition Staffing Levels |
NEd 04.0
|
08/12/13
|
NT
|
| Exit Counseling Session for Women |
NEd 08.0
|
08/12/13
|
NT
|
| Mid-Certification Assessment |
NEd 09.0
|
10/1/22
|
NT
|
|
IV. Breastfeeding
|
| Breastfeeding Personnel Guide |
BF 01.0
|
03/14/22
|
NT
|
| Local Agency Breastfeeding Coordinator |
BF 01.1
|
03/14/22
|
NT
|
Designated Breastfeeding Expert (DBE)
Qualifications and Responsibilities |
BF 01.2
|
03/14/22
|
NT
|
| Breastfeeding Peer Counselors Qualifications and Responsibilities |
BF 01.3
|
02/01/23
|
NT
|
| Breast Feeding Contact Guidelines |
BF 01.4
|
08/12/13
|
NT
|
| Breastfeeding Education |
BF 02.0
|
03/14/22
|
NT
|
| Breastfeeding Supplies |
BF 04.0
|
03/14/22
|
NT
|
| Manual Breast Pump |
BF 04.1
|
08/12/13
|
NT
|
| Personal Use Electric Breast Pump |
BF 04.2
|
08/12/13
|
NT
|
| Multi-User Electric Breast Pump |
BF 04.3
|
03/14/22
|
NT
|
| Supplemental Nursing System (SNS) |
BF 04.4
|
03/14/22
|
NT
|
| Breastfeeding Breast Pads |
BF 04.6
|
08/12/13
|
NT
|
| Breastfeeding Nipple Shields |
BF 04.7
|
03/14/22
|
NT
|
| Breastfeeding Contraindications |
BF 05.0
|
08/12/13
|
NT
|
|
V. Food Delivery Services
|
| Allowable Foods |
FDS 01.0
|
08/12/13
|
NT
|
| Allowable Food Selection Criteria |
FDS 01.1
|
11/15/16
|
NT
|
| Food Packages |
FDS 02.0
|
08/12/13
|
NT
|
| Prescribing the Food Package |
FDS 02.1
|
08/12/13
|
NT
|
| Maximum Food Allowed |
FDS 02.2
|
10/01/14
|
NT
|
| Food Package I and II - Infant |
FDS 02.2.1
|
08/12/13
|
NT
|
| Food Package III - Special Needs |
FDS 02.2.2
|
10/01/14
|
NT
|
| Food Package IV Child |
FDS 02.2.3
|
10/01/14
|
NT
|
| Food Package V - Pregnant and Providing Mostly Breast Milk |
FDS 02.2.4
|
10/01/14
|
NT
|
| Food Package VI- Postpartum |
FDS 02.2.5
|
10/01/14
|
NT
|
| Food Package VII - Fully Breastfeeding |
FDS 02.2.6
|
10/01/14
|
NT
|
| Tailoring Food Packages |
FDS 02.3
|
08/12/13
|
NT
|
| Lactose Reduced / Lactose Free Food Pkg |
FDS 02.3.1
|
08/12/13
|
NT
|
| Convenience Food Package |
FDS 02.3.2
|
08/12/13
|
NT
|
| Calcium Fortified Juice |
FDS 02.3.4
|
08/12/13
|
NT
|
| Soy Milk Substitution |
FDS 02.3.5
|
10/01/14
|
NT
|
| Changing a Food Package |
FDS 02.4
|
08/12/13
|
NT
|
| Addition of Juice / Cereal to Infant Food Package |
FDS 02.4.1
|
08/12/13
|
NT
|
| Contract Infant Formula |
FDS 03.1
|
08/12/13
|
NT
|
| Medical Documentation for Special Formula and Supplemental Foods |
FDS 03.2
|
08/12/13
|
NT
|
| Returned Formula and Nutritionals |
FDS 03.2.1
|
07/01/20
|
NT
|
| Special Formula Ordering |
FDS 03.2.2
|
08/01/18
|
NT
|
| Formula/Medical Foods for Medicaid Participants |
FDS 03.2.3
|
08/12/13
|
NT
|
| Medicaid Verification Over the Maximum of Formula |
FDS 03.2.4
|
11/01/14
|
NT
|
| Approved Formulas |
FDS 03.3
|
08/12/13
|
NT
|
| Non-Approved Formula / Products |
FDS 03.4
|
08/12/13
|
NT
|
| Security of eWIC Cards and Card Sleeves |
FDS 04.1
|
08/12/13
|
OT
|
| Food Benefits Issuance |
FDS 04.2
|
03/15/19
|
OT
|
| Food Benefit Issuance without Physical Presence |
FDS 04.2.1
|
08/01/17
|
NT |
| Prorating of Food Prescriptions |
FDS 04.4
|
08/12/13
|
NT
|
| Voiding Food Benefits |
FDS 04.6
|
08/12/13
|
OT
|
| Replacing eWIC Cards |
FDS 04.7
|
11/01/14
|
OT
|
|
VI. Participant Rights and Responsibilities
|
| Participant Rights and Responsibilities |
PRR 01.0
|
08/15/16
|
OT
|
| Proxy |
PRR 02.0
|
11/01/15
|
OT
|
| Caretaker |
PRR 02.1
|
08/15/16
|
OT
|
| Confidentiality and Release of Information |
PRR 03.0
|
11/01/18
|
OT
|
| Complaints and Civil Rights Procedures |
PRR 04.1
|
05/01/18
|
OT
|
| Fair Hearings |
PRR 06.0
|
08/12/13
|
OT
|
|
VII. Administration
|
| Caseload Assignment and Funding Allocations |
ADM 01.0
|
08/12/13
|
OT
|
| Interruption of Benefits |
ADM 02.0
|
08/12/13
|
OT
|
| Waiting Lists |
ADM 02.1
|
08/12/13
|
OT
|
| Funding Principles |
ADM 03.0
|
08/12/13
|
OT
|
| Fiscal Year Conversion |
ADM 03.3
|
08/12/13
|
OT
|
| Shared Purchases / Expenses |
ADM 03.4
|
11/14/18
|
OT
|
| Allowable WIC Expenditures and Allocations |
ADM 03.5
|
08/12/13
|
OT
|
| Unallowable Spending Costs |
ADM 03.6
|
08/12/13
|
OT
|
| Time & Effort Reporting |
ADM 03.7
|
07/01/17
|
OT
|
| Capital Expend., Eqpmnt. Cmptr. Purchase Requirements |
ADM 03.8
|
06/01/18
|
OT
|
| Cost Allocation for Shared Expenses |
ADM 03.9
|
11/13/18
|
OT
|
| Fiscal Record Keeping: General Guidelines |
ADM 03.10
|
08/12/13
|
OT
|
| CARDINAL State Accounting System |
ADM 03.11
|
04/01/17
|
OT
|
| WIC Services Plan (WSP) & Memorandum of Agreement |
ADM 04.0.1
|
08/12/13
|
OT
|
| Participant Surveys |
ADM 04.0.2
|
08/12/13
|
NT
|
| State Technical Assistance Review (STAR) |
ADM 04.1
|
02/01/18
|
OT
|
| Audits/Reviews |
ADM 04.2
|
06/01/18
|
OT
|
| Program Abuse and Sanctions |
ADM 05.0
|
08/12/13
|
OT
|
| Dual Participation |
ADM 05.1
|
08/12/13
|
OT
|
| Collection of Improp. Issued Benefits / Claims Against Participants |
ADM 05.2
|
08/12/13
|
OT
|
| Separation of Duties |
ADM 06.0
|
07/20/20
|
OT
|
| Conflict of Interest |
ADM 06.1
|
08/12/13
|
OT
|
| Program Accessibility |
ADM 08.0
|
04/01/17
|
OT
|
| Marketing and Media Outreach |
ADM 08.1
|
03/01/17
|
OT
|
| National Voter Registration Act |
ADM 09.0
|
08/12/13
|
OT
|
| Emergency Procedures |
ADM 10.0
|
08/12/13
|
OT
|
| Record Retention |
ADM 11.0
|
03/15/18
|
OT
|
| Clinic Closure – Relocation |
ADM 11.1
|
08/01/16
|
OT
|
| Full Disclosure |
ADM 12.0
|
08/12/13
|
OT
|
| System Outage |
ADM 13.0
|
11/01/15
|
OT
|
VIII. Vendor Management
|
| Inadequate Participant Access Assessment |
VEN 01.0
|
08/12/13
|
VT
|
| Retail Store Contact with Local Agencies |
VEN 03.0
|
04/01/17
|
VT
|
| Solicitation Issues |
VEN 04.0
|
08/12/13
|
VT
|
| Solicitation of Gifts and Retail Stores |
VEN 04.1
|
08/12/13
|
VT
|
| WIC Shopping Options |
VEN 05.0
|
08/12/13
|
VT
|
| WIC Approved Shelf Labels |
VEN 06.0
|
08/12/13
|
VT
|
| Retailer Complaint Handling |
VEN 07.0
|
08/12/13
|
VT
|
| WIC Retailer Training |
VEN 08.0
|
08/12/13
|
VT
|
| Personal Identification Number (PIN) and eWIC Card |
VEN 09.0
|
06/01/17
|
VT
|
|
IX. Forms
|
| Release of Information Form |
WIC-309
|
12/22
|
OT
|
| Release of Information Form (Spanish) |
WIC-309-S
|
12/22
|
OT
|
| Participant Rights and Responsibilities |
WIC-310
|
12/22
|
OT
|
| Participant Rights and Responsibilities (Spanish) |
WIC-310-S
|
12/22
|
OT
|
| Caretaker Designation Form |
WIC-311
|
06/16
|
OT
|
| Caretaker Designation Form (Spanish) |
WIC-311-S
|
06/16
|
OT
|
| Proxy Designation Form |
WIC-314A
|
06/16
|
OT
|
| Proxy Designation Form (Spanish) |
WIC-314A-S
|
06/16
|
OT
|
| Proxy Signature Form |
WIC-314B
|
06/16
|
OT
|
| Proxy Signature Form (Spanish) |
WIC-314B-S
|
06/16
|
OT
|
| Letter of Ineligibility |
WIC-315
|
06/16
|
OT
|
| Letter of Ineligibility (Spanish) |
WIC-315-S
|
06/16
|
OT
|
| Delayed Benefits Signature Authorization |
WIC-318
|
08/17
|
NT |
| Delayed Benefits Signature Authorization (Spanish) |
WIC-318-S
|
08/17
|
NT |
| Notification of Alternative Hours Form |
WIC-340
|
08/13
|
OT
|
| Complaint Against Store Form |
WIC-345A
|
02/22
|
VT
|
| Complaint Against Store Form (Spanish) |
WIC-345A-S
|
02/22
|
VT
|
| Complaint Against Participant or Local Agency Form |
WIC-345B
|
06/16
|
OT
|
| WIC Program Complaint Form (Spanish) |
WIC-345B-S
|
06/16
|
OT
|
| WIC Civil Rights Impact Analysis Form |
WIC-351
|
04/16
|
OT
|
| Civil Rights Training Log |
WIC-375
|
08/13
|
OT
|
| Affidavit |
WIC-383
|
06/16
|
OT
|
| Affidavit (Spanish) |
WIC-383-S
|
06/16
|
OT
|
| Receipt of Donated Formula Form |
WIC-388
|
07/20
|
NT
|
| Disqualification Letter for Program Abuse |
WIC-393
|
06/16
|
OT
|
| Disqualification Letter for Program Abuse (Spanish) |
WIC-393-S
|
06/16
|
OT
|
| Damaged / Breakage or Outdated Report for Special Formula |
WIC-394
|
08/13
|
VT
|
| Request for Special Food Package |
WIC-395
|
06/21
|
NT
|
| Special Formula Shipping Request |
WIC-396
|
08/13
|
NT
|
| Special Formula Replacement Request |
WIC-397
|
08/13
|
NT
|
| Separation of Duties Log |
WIC-400
|
08/13
|
OT
|
| eWIC Card Stock and Card Holder Inventory Log |
WIC-402
|
08/13
|
OT
|
| Local Agency Returned Formula and Nutritional Inventory Form |
WIC-404
|
07/20
|
NT
|
| Local Agency Formula and Nutritional Donation Log |
WIC-405
|
07/20
|
NT
|
| Local Agency Formula and Nutritional Disposal Log |
WIC-406
|
07/20
|
NT |
| Inadequate Participant Access Assessment (IPA) Form |
WIC-410
|
08/13
|
VT
|
| Racial / Ethnic Data Collection Form |
WIC-415
|
06/05
|
OT
|
| Racial / Ethnic Data Collection Form |
WIC-415-S
|
06/05
|
OT
|
| WIC System Outage Form for Eligibility |
Crossroads-01
|
08/13
|
OT
|
| WIC System Outage Form for Nutrition |
Crossroads-02
|
08/13
|
NT
|
| WIC Local Agency Personnel Contact Change |
Email-01
|
10/13
|
OT
|
| Policy Review Request Form |
MISC-001
|
08/13
|
OT
|
|
X. Appendices
|
| Combat Pay |
Appendix 1
|
08/13
|
OT
|
| Medicaid Financial Eligibility |
Appendix 2
|
07/18
|
OT
|
| Regulations Governing Dietitians and Nutritionists |
Appendix 3
|
08/13
|
NT
|
| Certification of Records Destruction Form |
Appendix 6
|
01/13
|
OT
|
| STAR Review Tool |
Appendix 7
|
03/19
|
OT
|
| Formula Manufacturers |
Appendix 8
|
08/13
|
NT
|
| Food Standards |
Appendix 11
|
06/18
|
NT
|
| Allowable Food Application Form |
Appendix 12
|
08/13
|
NT
|
| Request for New Food Item Consideration |
Appendix 14
|
08/13
|
NT
|
| Determine Nutrition Risk – Anthropometric |
Appendix 15
|
08/13
|
NT
|
| Breastfeeding Peer Counselor Standards of Practice |
Appendix 16
|
08/13
|
NT
|
| Breastfeeding Peer Counselor Scope of Practice |
Appendix 17
|
3/22
|
NT
|
| Overdue Breast Pump Letter |
Appendix 18
|
3/22
|
NT
|
| Regulations Regarding Breastfeeding |
Appendix 19
|
3/22 |
NT |
|
|
|
Glossary
|
02/18
|
OT
|
XII. Emergency Procedures
|
| Remote WIC Services |
|
11/22
|
NT
|
