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Division of Public Health Agreement Addendum FY 1415-Page 1 of 4 Local Health Department Legal Name Women's and Children's Health Section Nutrition Services Branch DPH Section/Branch Name 403 WIC
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How to fill out wic agreement addendum sfy
How to fill out the WIC agreement addendum sfy:
01
Obtain the form: Visit your local WIC office or go online to the official WIC website to find and download the WIC agreement addendum sfy form. Make sure you have the latest version of the form.
02
Read the instructions: Before proceeding with filling out the form, carefully read the instructions provided. This will help you understand the purpose of the addendum and how to accurately complete it.
03
Fill in identifying information: Start by providing your personal details in the designated sections of the form. This typically includes your full name, address, phone number, and email address. Make sure to write legibly and use the correct format.
04
Indicate WIC agency information: Next, you'll need to supply details about your affiliated WIC agency. This might include the agency's name, address, and contact information. Refer to any supporting documents or communication you have received from the WIC office to ensure accurate information.
05
Specify agreement terms: The addendum form will likely contain multiple sections or paragraphs outlining specific terms or agreements related to your participation in the WIC program. Carefully review each section, and if you agree with the terms presented, you can sign or initial as required.
06
Seek professional advice if needed: If you come across any sections of the form that you do not fully understand or if you have any questions, it is recommended to seek guidance from the WIC agency or a knowledgeable professional. They can provide clarification and ensure you fill out the addendum correctly.
Who needs WIC agreement addendum sfy?
01
WIC participants: Individuals who are currently enrolled in the WIC program may be required to fill out the WIC agreement addendum sfy form. This helps ensure that both the participant and the WIC agency are aware of and agree upon the terms and conditions of the program.
02
WIC agency representatives: WIC agency representatives who are responsible for overseeing participant compliance and adherence to program guidelines may also need to be familiar with the WIC agreement addendum sfy. This allows them to accurately inform participants about their rights and responsibilities.
03
Authorized third parties: In some cases, authorized third parties such as healthcare providers or other professionals involved in the administration or enforcement of the WIC program may need to review and understand the WIC agreement addendum sfy. This allows them to support and educate participants based on the outlined terms.
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What is wic agreement addendum sfy?
The wic agreement addendum sfy is a supplemental form that is added to the Women, Infants, and Children (WIC) agreement for a specific state fiscal year (sfy).
Who is required to file wic agreement addendum sfy?
The wic agreement addendum sfy must be filed by all WIC authorized vendors.
How to fill out wic agreement addendum sfy?
The wic agreement addendum sfy can be filled out online on the official WIC website or submitted in person at the local WIC office.
What is the purpose of wic agreement addendum sfy?
The purpose of the wic agreement addendum sfy is to update and make changes to the original WIC agreement for a specific state fiscal year.
What information must be reported on wic agreement addendum sfy?
The wic agreement addendum sfy must include any changes to the vendor's contact information, pricing, and eligible products.
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