HI WIC FD 941C 2014 free printable template

Form available at: http://health.hawaii.gov/wic. A. Patient ... Medical documentation valid for: 1 month 2 months 3 months 4 months 5 months.

How to fill out HI WIC FD 941C

How to fill out HI WIC FD 941C

1. Gather required documents: Have your identification, proof of income, and residency ready.
2. Access the HI WIC FD 941C form: Download it from the official WIC website or obtain a physical copy from a WIC clinic.
3. Personal Information: Fill in your name, address, phone number, and other personal details on the form.
4. Indicate household members: List all individuals living in your household, including their names, ages, and relationship to you.
5. Income details: Provide information about your family's income, stating the source and amount.
6. Check nutrition risk: Answer the questions regarding any health or nutrition-related issues.
7. Review the form: Ensure all information is accurate and complete before submitting.
8. Submit the form: Send it to your local WIC office via mail or drop it off in person.

Who needs HI WIC FD 941C?

1. Pregnant women needing nutritional support.
2. New mothers breastfeeding infants.
3. Caregivers of children under the age of five who need assistance with nutrition.
4. Families with low-income seeking access to healthy food options and nutrition education.

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 used by healthcare providers to report WIC (Women, Infants and Children) program expenditures and claims related to nutrition services provided to eligible individuals.

Who is required to file HI WIC FD 941C?

Healthcare providers and organizations that participate in the WIC program and receive reimbursements are required to file HI WIC FD 941C to document their service delivery and ensure compliance with program guidelines.

How to fill out HI WIC FD 941C?

To fill out HI WIC FD 941C, you need to provide relevant information such as agency details, expenditure categories, number of participants served, and any required financial data. It's essential to follow the instructions provided with the form for accuracy.

What is the purpose of HI WIC FD 941C?

The purpose of HI WIC FD 941C is to collect and report necessary financial and programmatic information from WIC providers to ensure accountability, transparency, and efficient use of program resources.

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

The information that must be reported on HI WIC FD 941C includes the provider's agency name, address, dates of service, total expenditures, types of services provided, and the number of eligible participants served during the reporting period.