HI WIC FD 941C 2019-2025 free printable template

State of Hawaii, Department of Health Women, Infants and Children (WIC) Program Medical Documentation Form WIC Clinic:Complete sections A, B, C and D for all patients. Form available at: http://health.hawaii.gov/wicPhone

How to fill out HI WIC FD 941C

How to fill out HI WIC FD 941C

1. Begin by obtaining the HI WIC FD 941C form from your local WIC office or online.
2. Fill in the participant's name in the designated section.
3. Indicate the participant's date of birth and address.
4. Provide the caregiver's name and contact information if applicable.
5. List the household members and their ages.
6. Complete the income section by providing the required financial documentation or details.
7. Review the form for completeness and accuracy before submission.
8. Submit the completed form to your local WIC agency as directed.

Who needs HI WIC FD 941C?

1. Families or individuals who are applying for the Women, Infants, and Children (WIC) program in Hawaii.
2. Pregnant women, new mothers, infants, and children up to age five who meet the eligibility requirements.

People Also Ask about

Who is the vendor for WIC in Hawaii?

A: Hawaii WIC has contracted with chosen Fidelity Information Services (FIS) to serve as our eWIC Service Provider.

Does Hawaii WIC cover Enfamil?

Hawaii WIC cannot provide the following formulas, even with medical documentation: ❖ No Abbott Nutrition standard soy infant formula: Similac Soy Isomil ❖ No Mead Johnson standard cow milk infant formulas: Enfamil PREMIUM, Enfamil A.R., or Enfamil Gentlease. ❖ No Gerber standard infant formulas: Any Good Start formula.

Does WIC work in Hawaii?

To qualify for Hawaii WIC services you must be either a pregnant, breastfeeding, or postpartum woman, or have children under 5 years old who have nutritional needs, meet federal income guidelines and be a resident of Hawaii.

Who funds WIC in Illinois?

WIC is administered by the Illinois Department of Human Services (IDHS) and is funded by the United States Department of Agriculture (USDA).

Does Hawaii have WIC?

To qualify for Hawaii WIC services you must be either a pregnant, breastfeeding, or postpartum woman, or have children under 5 years old who have nutritional needs, meet federal income guidelines and be a resident of Hawaii.

Who is the director of the WIC program in Hawaii?

Melanie Murakami - WIC Director - Hawaii Department of Health WIC Services Branch | LinkedIn.

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What is HI WIC FD 941C?

HI WIC FD 941C is a specific form related to the Women, Infants, and Children (WIC) program in Hawaii, used for reporting and documenting financial data.

Who is required to file HI WIC FD 941C?

Organizations and agencies participating in the WIC program in Hawaii that receive federal funding are required to file HI WIC FD 941C.

How to fill out HI WIC FD 941C?

To fill out HI WIC FD 941C, entities must gather relevant financial data as instructed on the form and complete all required sections, ensuring accuracy and compliance with WIC guidelines.

What is the purpose of HI WIC FD 941C?

The purpose of HI WIC FD 941C is to collect financial information necessary for monitoring expenses and ensuring proper use of federal funds in the WIC program.

What information must be reported on HI WIC FD 941C?

The information that must be reported on HI WIC FD 941C includes expenditures, program revenues, and other financial data relevant to the operation of the WIC program.