Home Food Delivery Systems


DOES NOT APPLY (PROCEED TO NEXT SECTION) - Checked

1. Home Food Delivery Systems Overview

  1. Home delivery vendors include (check all that apply):
    • Dairies
    • Private delivery service doing WIC business only
    • Private delivery service
    • Other (specify):
  2. Participants who receive home food delivery:
    • Are notified in writing of the types and quantities of foods
    • Are issued food instruments that they sign and provide to the vendor when the food is delivered
    • Indicate by authorized signature on a FI, receipt or signature document, the supplemental foods received
    • Other (specify):
  3. Supplemental foods may be delivered:
    • Only to the participant of record
    • To the participant of record or proxy of record
    • To any adult at home during time of delivery
    • To anyone at home at the time of delivery
    • Other (specify):

ADDITIONAL DETAIL: Food Delivery Appendix and/or Procedure Manual (citation):

2. Documentation

  1. The forms verifying delivery are reconciled against vendor invoices:
    • Weekly
    • Monthly reconciliation of the signed FI or other signed receipts or signature documents from participant or proxies.
    • Other (specify):
  2. Signatures of participants, who sign the food receipt document/food instruments, are compared to the signature on file.
    • No
    • Yes, sample
    • Yes, 100%

ADDITIONAL DETAIL: Food Delivery Appendix and/or Procedure Manual (citation):