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DEPARTMENT OF MENTAL HEALTH POLICY/PROCEDURE SUBJECT POLICY NO. APPROVED BY: Director EFFECTIVE DATE PAGE 307.03 04/01/2009 1 of 3 SUPERSEDES LOS ANGELES COUNTY POLICY FOR CONDITIONAL LPS AUTHORIZATION

How to fill out wic 5150 form

How to fill out WIC 5150 form:

1. Start by obtaining the WIC 5150 form, which is typically available online on the official website of the organization administering the WIC program in your area.
2. Begin by entering your personal information accurately in the designated fields. This may include your name, address, contact details, and any other requested details.
3. Read the instructions carefully to understand the purpose of each section and how to complete it correctly.
4. Provide information about your household, such as the number of people residing with you and their relationship to you.
5. Indicate your income details accurately to determine your eligibility for the WIC program. This may involve providing information about your household's income sources and amounts.
6. Answer any additional questions pertaining to your financial situation or circumstances that may influence your eligibility for the WIC program.
7. If applicable, provide information about any additional benefits or assistance programs you are receiving, as this may affect your eligibility or benefit amount.
8. Review the completed form meticulously to ensure all information is accurate and legible.
9. Sign and date the form in the designated section to certify that the information provided is true and accurate to the best of your knowledge.
10. Keep a copy of the filled-out WIC 5150 form for your records before submitting it to the appropriate WIC program office.

Who needs the WIC 5150 form:

1. Individuals or households applying for the WIC program benefits need the WIC 5150 form.
2. Pregnant women, postpartum women, and infants or children under the age of five are typically eligible for WIC benefits.
3. Eligibility for the WIC program is often determined based on income and nutritional risk, so individuals or households meeting specific criteria may need to complete the WIC 5150 form to apply for the program.

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