Eligibility Determination and Documentation


  1. 1. Application Process
  2. 2. Residency, Identity and Physical Presence Requirements
  3. 3. The State agency requires applicants to submit proof of categorical eligibility for (check all that apply):
  4. 4. Income Limits for Eligibility
  5. 5. Income Eligibility Documentation
  6. 6. In determining an applicant's income eligibility for WIC, the State agency excludes basic allowance for housing received by military services personnel residing off military installations and in privatized housing, whether on- or off-base.
  7. 7. The State agency excludes cost-of-living allowances for military personnel on duty outside of the contiguous 48 States (OCONUS COLA) from applicant income for purposes of WIC income determination
  8. 8. The State agency defines the economic unit in accordance with Food and Nutrition Service regulations and policy instructions
  9. 9. The State agency has specific policies or lists examples concerning the determination of the economic unit for (check all that apply):
  10. 10. Mid-Certification Disqualification

1. Application Process

  1. The State agency requires all local agencies to use a standardized application process for all persons applying for the WIC Program
    • Yes - Checked
    • No
  2. The State agency shares State wide or at local agency (check one), a common income application or certification form with (check all that apply):
    • no other benefit programs - Checked
    • Medicaid
    • TANF
    • Food Stamp Program
    • MCH
    • other reduced price health care program(s)
    • other (specify):

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Part 3 Certification Standards, 1 and 4

2. Residency, Identity and Physical Presence Requirements

  1. The State agency requires documentation of residency
    • Yes - Checked
    • Signed statement that documentation of residency information is not available and why (e.g. homeless, theft, fire)
    • No (Specify why, e.g., ITOs and Alaska natives who are exempt from this requirement.)
  2. The State agency has special residency policies and procedures for how the following special categories should be treated (check all that apply):
    • homeless applicants - Checked
    • institutionalized applicants - Checked
    • migrants - Checked
    • Indian Tribal Organizations
    • none other (specify):
  3. The State agency has reciprocal agreements concerning residency with other States
    • Yes (specify States):
    • No - Checked
  4. The State agency requires proof of identity from each applicant at certification
    • Yes - Checked
    • No (If not, why not?)
  5. The State agency requires physical presence of the applicant or a valid exception to be documented:
    • Yes except for the following condition(s): - Checked
      • applicant or parent/caretaker is an individual with disabilities which prevent him/her from being physically present at the WIC clinic (e.g., medical equipment, bed-rest, or serious illness exacerbated by coming in to clinic). - Checked
      • applicant is an infant or child receiving documented ongoing health care from any health care provider, including the local agency; being physically present would pose an unreasonable barrier; and the infant or child was present at his/her initial WIC certification.
      • applicant is an infant under 8 weeks of age who cannot be present at the time of certification (for a reason determined appropriate by the local agency) and for whom all necessary certification information is provided.
      • applicant is an infant or child who was present at his/her initial certification; was present at certification within the one-year period of the most recent determination; and is under the care of one parent and that parent works, or is under the care of two parents and both work; and that working status presents a barrier to bringing the infant or child in to the WIC clinic.
  6. The State agency uses temporary (30-day) certifications for individuals who do not present necessary proof of residency and/or identity at the time of application.
    • Yes
    • No - Checked

3. The State agency requires applicants to submit proof of categorical eligibility for (check all that apply):

  • all pregnant women - Checked
  • pregnant women not visibly pregnant
  • postpartum women
  • children - Checked
  • infants - Checked
  • other (specify):

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): WIC PPM, Part 3, Sections 1-4

4. Income Limits for Eligibility

  1. The State agency gross income limit for income eligibility is 185% of the federal income guidelines
    • Yes, with no local agency exceptions - Checked
    • Yes, with local agency variation
    • No, with no local agency exceptions
      (specify State maximum percent of poverty: %)
    • No, with local agency variation
      (specify State maximum percent of poverty: %)
    • The State agency implements income eligibility guidelines concurrently with Medicaid
  2. Please attach a copy of the income guidelines in the Appendix or the appropriate citation in the Procedure Manual.
  3. The State agency requires documentation of an applicant's, or certain family members' eligibility to receive benefits in the following means-tested programs that confer adjunctive income eligibility for WIC, as set forth in 246.7(d)(2)(vi):
    • TANF (specify State "percent of poverty") - 133% Poverty Level - Checked
    • Food Stamp Program- Checked
    • Medicaid (specify State "percent of poverty" for each) - Checked
      • Pregnant women and infants - 200% Poverty Level
      • Children - 200% Poverty Level ,
      • Other categorically eligible women
  4. The State agency uses documented eligibility for/participation in other means-tested programs to establish WIC income eligibility (check all that apply and the poverty levels used for each):
    • Free or Reduced-Price School Lunch - 185%
    • SSI
    • other State-provided health insurance (specify State "percent of poverty" maximum %)
    • FDPIR
    • other (specify):
  5. Individuals are required to document that they or a family member are certified as eligible to receive TANF, Medicaid, or Food Stamp benefits or, under the State option, certified as eligible to receive benefits in State-administered programs by providing:
    • program ID card or notice of eligibility - Checked
    • documentation of participation in State-administered programs (and such programs require documentation of income and have income guidelines at or below WIC's income guideline of 185% of poverty). (Program[s]: KidCare, now known as All Kids ) - Checked

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Part 3, Certification Standards, Section 3

5. Income Eligibility Documentation

  1. For WIC applicants whose income eligibility is not based on adjunctive or automatic income eligibility in another means-tested program, the State requires (check all that apply):
    • Documentation of income information - Checked
    • Signed statement that documentation of income information is not available and why - Checked
    • Notation in the casefile if the applicant declares no income
    • other (specify):
  2. Exceptions to income documentation are made for the following:
    • The necessary information is not available
    • The income documentation presents an unreasonable barrier to participation as determined by the State agency - Checked
    • Those applicants with no income - Checked
    • Those applicants who work for cash - Checked
    • other (specify):
  3. If the applicant does not supply income documentation at the certification appointment, and has at least one qualifying nutrition risk, local agencies are generally instructed to do the following:
    • Certification process is terminated and no food instruments are provided; appointment rescheduled - Checked
    • Temporary certification (not to exceed 30 days) is completed and food instruments are provided. However, if applicant does not provide documentation within 30 days, applicant is determined ineligible.
    • Other (specify):
  4. The State agency requires State-wide, or at local agency (check one), the verification of applicant income information
    • No - Checked
    • Yes (check all sources required, as appropriate):
      • employer
      • public assistance offices
      • State employment offices (wage match, unemployment)
      • Social Security Administration
      • school districts/offices
      • collateral contacts
      • other (specify):
  5. The State agency has specific policies that define actions to be taken for mid-certification changes in participant income circumstances.
    • Yes - Checked
    • No
  6. The State agency allows documentation of alternate income procedures for Indian or Indian Health Service (IHS) operated local agencies
    • Yes
    • No
    • Not Applicable - Checked
  7. The State agency has specific policy that addresses income from benefits provided under certain regulatory Federal programs
    • Yes - Checked
    • No

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Part 3, Certification Standards, Section 3

6. In determining an applicant's income eligibility for WIC, the State agency excludes basic allowance for housing received by military services personnel residing off military installations and in privatized housing, whether on- or off-base.

  • Yes, State-wide - Checked
  • No

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Part 3, Certification Standards, section 3-4

7. The State agency excludes cost-of-living allowances for military personnel on duty outside of the contiguous 48 States (OCONUS COLA) from applicant income for purposes of WIC income determination

  • Yes, State-wide - Checked
  • No

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation):

8. The State agency defines the economic unit in accordance with Food and Nutrition Service regulations and policy instructions

  • Yes - Checked
  • No (if not, why not)

Provide the definition of an economic unit used by the State agency in the Appendix or the appropriate citation in the Procedure Manual.

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Part 3, Certification Standards , Section 1

9. The State agency has specific policies or lists examples concerning the determination of the economic unit for (check all that apply):

  • foster children - Checked
  • divorced/legally separated parents; step parents
  • absentee spouse (military hardship tours, etc.)
  • cohabitation
  • institutionalized applicants (including incarcerated applicants)
  • homeless applicants - Checked
  • minors ("emancipated" minors) - Checked
  • separate economic units under the same roof - Checked
  • striker/unemployed
  • students away at school
  • other (specify):

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Part 3, Certification Standards , Section 1

10. Mid-Certification Disqualification

  1. The State agency ensures that local agencies are required to stipulate that an individual is not automatically disqualified mid- certification due to the fact that she/he no longer participates in one or more of the Programs for which they were originally determined adjunctively/automatically income eligible.
    • Yes - Checked
    • No
  2. WIC regulations specify that when income eligibility is reassessed mid-certification, State/local agencies are required to reevaluate the programs for which the individual could be determined adjunctively/automatically income eligible. If the individual cannot qualify based on eligibility for one of these programs, eligibility must be determined based on WIC income guidelines and disqualification made only after all of these  options are exhausted. The State ensures its policy and procedures comply with this requirement:
    • Yes - Checked
    • No