Get the free WIC SHOPPER CONTRIBUTION FORM - procure.ohio.gov - procure ohio
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Attachment C WIC SHOPPER CONTRIBUTION FORM STORE NUMBER:FOOD INTERAGENCY NAME NUMBER:BRAND NAME UNIT PRICEQUANTITYUNIT COSTCOMMENTSAGENCY ADDRESS acknowledge receipt of the above food items from the
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How to fill out wic shopper contribution form
How to fill out wic shopper contribution form
01
To fill out the WIC Shopper Contribution Form, follow these steps:
02
Start by entering the date at the top of the form.
03
Provide your full name, address, and phone number in the designated fields.
04
Indicate the number of people in your household by selecting the appropriate option.
05
In the next section, specify the income frequency (weekly, bi-weekly, etc.) and the total household income.
06
If applicable, provide any additional sources of income in the corresponding fields.
07
Proceed to list the details of your monthly expenses, such as rent, utilities, childcare, etc.
08
Include any deductions you may have, such as medical expenses or child support payments.
09
If you receive SNAP or TANF benefits, specify the amount you receive.
10
Finally, sign and date the form at the bottom before submitting it to the appropriate authority.
11
Please note that these instructions serve as a general guideline and may vary depending on your specific WIC program.
Who needs wic shopper contribution form?
01
The WIC Shopper Contribution Form is required for individuals or families who participate in the WIC (Women, Infants, and Children) program.
02
This form is used to assess the financial need of WIC participants and determine their eligibility for certain benefits and services.
03
If you are a WIC participant or plan to apply for WIC benefits, you will likely need to fill out this form as part of the application process.
04
It is recommended to consult with your local WIC office or program administrator for more specific information on who needs to fill out this form.
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What is wic shopper contribution form?
The WIC Shopper Contribution Form is a form used by participants in the Women, Infants, and Children (WIC) program to record and report the items they have purchased using their WIC benefits.
Who is required to file wic shopper contribution form?
All participants in the WIC program are required to fill out and submit the WIC Shopper Contribution Form.
How to fill out wic shopper contribution form?
Participants can fill out the WIC Shopper Contribution Form by detailing the items purchased with their WIC benefits and providing any additional required information.
What is the purpose of wic shopper contribution form?
The purpose of the WIC Shopper Contribution Form is to track and monitor the use of WIC benefits by participants to ensure compliance with program guidelines.
What information must be reported on wic shopper contribution form?
Participants must report the specific items purchased with their WIC benefits, as well as the store where the items were purchased and the date of purchase.
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