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Expires: (For WIC use only.)WIC Medical Documentation Form North Dakota Department of Health Division of Nutrition and Physical Activity WIC Program authorize a special WIC approved formula or WIC

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How to fill out for wic use only

01

To fill out for WIC use only, follow these steps:

02

Start by providing all the necessary personal information of the applicant such as their name, date of birth, gender, address, phone number, and email.

03

Next, specify the type of assistance or program the applicant is applying for.

04

Provide any additional details or documents required by WIC for verification purposes.

05

Complete the income section by accurately reporting the household income and providing any supporting documentation if necessary.

06

Answer all the questions related to eligibility criteria, household members, and any specific dietary or medical needs.

07

Review the filled-out form thoroughly to ensure all information is accurate and correct any mistakes if found.

08

Sign and date the form to acknowledge that all the provided information is true and accurate.

09

Submit the filled-out form to the appropriate WIC office either in person or through the designated submission method.

10

Keep a copy of the filled-out form for your records.

Who needs for wic use only?

01

Those who need the form for WIC use only include individuals or families who are applying for the Women, Infants, and Children (WIC) program to receive nutritional support and education.

02

WIC is designed to assist low-income pregnant women, postpartum women, breastfeeding mothers, infants, and young children up to the age of 5 who are at nutritional risk.

03

Filling out the form for WIC use only is necessary for those who meet the eligibility criteria and wish to avail the benefits provided by the program.

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What is for wic use only?

For wic use only refers to information or items that should only be used by the Women, Infants, and Children (WIC) program for their specific purposes.

Who is required to file for wic use only?

Certain authorized personnel or entities involved in the WIC program are required to file information under the for wic use only category.

How to fill out for wic use only?

To fill out for wic use only, ensure that only relevant information for the WIC program is provided in the designated section.

What is the purpose of for wic use only?

The purpose of for wic use only is to protect sensitive information and ensure that data is used solely for WIC-related activities.

What information must be reported on for wic use only?

Any data that is designated as for wic use only must include details related to WIC program participants, benefits, or services.

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