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Print Form TENNESSEE DEPARTMENT OF HEALTH REQUEST FOR WIC ELIGIBLE THERAPEUTIC PRODUCTS AND SUPPLEMENTAL FOODS MUST BE COMPLETED BY HEALTHCARE PROVIDER Patient's Name: Date of Birth: Formula Requested:

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What is request for wic eligible?

The request for WIC eligible is a form that individuals or households need to fill out in order to determine their eligibility for the Women, Infants, and Children (WIC) program. WIC is a federal assistance program that provides nutrition education, healthy food, and support to low-income pregnant women, new mothers, and young children.

Who is required to file request for wic eligible?

Pregnant women, new mothers, and young children from low-income households are required to file a request for WIC eligibility in order to apply for the program.

How to fill out request for wic eligible?

To fill out a request for WIC eligibility, individuals or households need to visit their local WIC office or online application platform and provide necessary information such as income, residency, and household size. They may also need to provide documentation to support their eligibility.

What is the purpose of request for wic eligible?

The purpose of the request for WIC eligibility is to determine if an individual or household meets the income and other eligibility requirements set by the WIC program. This helps ensure that the limited program resources are allocated to those who are most in need.

What information must be reported on request for wic eligible?

The request for WIC eligibility typically requires individuals or households to report information such as their income, residency, household size, and other demographic details. They may also need to provide documentation to support the reported information.

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