Chapter Two Certification - azdhs.gov

1 Chapter Two Certification Chapter Two Certification Arizona WIC Program Original: March 1997 Policy and Procedure Manual 2-2 Revision: June 2017 Contents Chapter Two Certification .. 2-1 Overview .. 2-8 Policy .. 2-8 In This Chapter .. 2-8 Section A Certification 2-9 Eligibility Determination .. 2-9 Service Timeframe: Within 10 days .. 2-9 Service Timeframe: Within 20 days .. 2-9 Extension of Timetable .. 2-9 Missed Appointment Procedures .. 2-9 Local Agency Responsibility .. 2-10 Components of Certification .. 2-10 Food Benefit Issuance .. 2-10 Documentation Provided .. 2-11 Arizona WIC Program ID Folder/eWIC Card Holder (if applicable) .. 2-11 Certification Periods .. 2-11 Pregnant Women .. 2-11 Postpartum Women .. 2-12 Infant Less Than Six Months Old .. 2-12 Infant More Than Six Months Old.

2 2-12 Children .. 2-12 Special Conditions .. 2-13 Women s Nutrition Risk Determination .. 2-13 Section B Physical Presence/Identification .. 2-14 Physical Presence 2-14 Exceptions to Physical Presence .. 2-14 Documentation of Exceptions .. 2-14 Certification of Women and Children in Outreach Locations .. 2-15 Documentation of 2-16 Applicants with No Proof of Identity .. 2-17 Section C Residency .. 2-18 Residency .. 2-18 State Service Area .. 2-18 Documentation of Residency .. 2-18 Chapter Two Certification Arizona WIC Program Original: March 1997 Policy and Procedure Manual 2-3 Revision: June 2017 Arizona Address Confidentiality Program .. 2-19 Institutional 2-19 Non-Compliant Institutions Participants .. 2-19 Applicants with No Proof of Residency .. 2-20 Homeless Applicants/Participants .. 2-20 Refugees.

3 2-20 Section D Ethnicity and Race Data Collection .. 2-21 Race/Ethnicity Determination .. 2-21 Section E Income Eligibility .. 2-22 Policy .. 2-22 Determining Household Size/ Economic Unit .. 2-22 AZ KidsCare .. 2-22 Adopted Child .. 2-22 Foster Child .. 2-23 Military Family .. 2-23 Pregnant Woman .. 2-23 Resident of Institutions .. 2-24 2-24 Separated Family .. 2-24 Custody .. 2-24 Teen .. 2-24 In-stream Migrant Worker .. 2-24 Refugees .. 2-24 Income Standards .. 2-25 Adjunctive Eligibility .. 2-25 Documentation of Adjunctive Eligibility .. 2-25 Documentation of Income .. 2-26 Applicants with No Proof of Income .. 2-27 Zero Income .. 2-27 No Proof of Income, Identification, or Residency Within Thirty (30) Days of Certification .. 2-28 Migrants .. 2-28 Reassessment of Income .. 2-28 Household Income Ineligible Termination.

4 2-29 No Longer Adjunctively Eligible During a Certification Period .. 2-29 Income .. 2-29 Chapter Two Certification Arizona WIC Program Original: March 1997 Policy and Procedure Manual 2-4 Revision: June 2017 Wages .. 2-29 Active Military Payments .. 2-30 Farm/Self-Employment .. 2-30 Social Security .. 2-30 Dividends/ Trusts/Rental Income .. 2-30 Public Assistance .. 2-30 Unemployment .. 2-30 Disability .. 2-30 Retirement/ Pensions/ Annuities .. 2-30 Alimony and Child Support .. 2-30 Contributions .. 2-31 Royalties .. 2-31 Other Cash Income .. 2-31 Lump Sum Payments .. 2-31 Student Financial Assistance .. 2-31 Census Workers .. 2-31 Military Exclusions .. 2-31 In-Kind/Non-Cash Benefits .. 2-32 Federal Program Benefits .. 2-32 Loans .. 2-33 Lump Sum/Large Cash Payments .. 2-33 Employer Contributions.

5 2-33 Income of/Payments to Native Americans .. 2-33 Section F Categorical Eligibility .. 2-34 Pregnant Woman .. 2-34 Postpartum Woman .. 2-34 Breastfeeding Woman .. 2-34 Infant .. 2-34 Child .. 2-34 Section G Health and Nutrition Assessment .. 2-35 Policy .. 2-35 USDA Criteria .. 2-35 Arizona Risk Criteria .. 2-35 Other Risk Factors .. 2-35 Certifiers .. 2-36 Chapter Two Certification Arizona WIC Program Original: March 1997 Policy and Procedure Manual 2-5 Revision: June 2017 Health and Nutrition Assessment .. 2-36 Frequency of Assessment .. 2-37 Completing an Assessment and Documentation .. 2-37 Monitoring of Assessment .. 2-38 Section H Risk Identification .. 2-39 Policy .. 2-39 Documentation .. 2-39 Self-Reporting or Self- Diagnosis .. 2-39 Section I Priorities .. 2-40 Special Note .. 2-40 Priority I.

6 2-40 Priority II .. 2-40 Priority III .. 2-40 Priority IV .. 2-40 Priority V .. 2-40 Priority VI .. 2-40 Priority VII .. 2-40 Out-of -State Transfers .. 2-41 Section J WIC Rights and Obligations .. 2-42 WIC Rights and Obligations .. 2-42 Documentation .. 2-42 Paper Rights and Obligations form .. 2-42 Availability of Health Services .. 2-43 Food Delivery System .. 2-43 Section K Voter Registration .. 2-45 WIC Voter Registration .. 2-45 Arizona Voter Registration Form .. 2-45 WIC Program Offer of Voter Registration Form .. 2-45 HANDS Documentation .. 2-46 Voter Registration Documentation .. 2-46 Section L WIC Rules and Regulations and Education .. 2-47 Documentation .. 2-47 Education .. 2-47 WIC Rules and Regulations .. 2-47 Section M Referrals .. 2-48 Chapter Two Certification Arizona WIC Program Original: March 1997 Policy and Procedure Manual 2-6 Revision: June 2017 Documentation.

7 2-48 Referrals .. 2-48 Updated List of Referrals .. 2-48 Release of 2-48 Section N Ineligibility .. 2-49 Notification of Ineligibility .. 2-49 Information About Reapplication .. 2-49 Right to Fair Hearing .. 2-49 Referrals .. 2-49 Timeline .. 2-49 Section O Authorized Representative .. 2-50 Policy .. 2-50 Procedures for Naming Authorized Representatives .. 2-50 Change of Authorized Representative during a Certification period ( Change of Guardianship and/or Custody) .. 2-51 Section P Proxies .. 2-53 Policy .. 2-53 Procedure .. 2-53 Section Q Waiting Lists .. 2-55 Policy .. 2-55 Use of Waiting Lists .. 2-55 Managing Caseload .. 2-55 Predicting Caseload .. 2-55 10/20 Day Rule .. 2-56 Waiting 2-56 Files .. 2-57 Notification/ Recall from Waiting List .. 2-57 Date of Ineligibility .. 2-57 False Expectation.

8 2-58 Referrals to Other Programs .. 2-58 Breastfeeding Women Who Quit Breastfeeding .. 2-58 Transfers (After Certification ) .. 2-58 Notification of Referral Agencies .. 2-58 Section R Transfer of Certification .. 2-59 Verification of Certification (VOC) .. 2-59 Chapter Two Certification Arizona WIC Program Original: March 1997 Policy and Procedure Manual 2-7 Revision: June 2017 Partially Complete Verification of Certification (VOC) .. 2-59 Retention of VOC/Rights and Obligation .. 2-59 Transfer When a Waiting List Exists .. 2-59 Special Conditions .. 2-60 In-State Transfers .. 2-60 Out-of -State Transfers .. 2-60 Transferring out of Arizona WIC .. 2-61 Transfers in of Migrants and Native Americans .. 2-61 WIC Overseas .. 2-61 Appendix A: Waiting List Notification Form .. 2-62 Appendix B: Rights & Obligations Forms (Formerly Consent/Release Form).

9 2-64 Appendix C: Instructions for WIC Identification ( ) Folder .. 2-67 Appendix D: Statement of Documentation Form .. 2-71 Appendix E: Determining Income Eligibility & Income Guidelines .. 2-74 Appendix F: Health and Nutrition Assessment .. 2-77 Appendix G: Instructions for Documenting the Health and Nutrition Assessment .. 2-95 Appendix H: Arizona WIC Risk Table FY2018 .. 2-97 Appendix I: Risk Factors Not Currently Recognized by Arizona Table .. 2-106 Appendix J: Notification of Ineligibility Form .. 2-108 Appendix K: Proxy Certification Form .. 2-111 Appendix L: Sample Letter for Referral Agency Communication Regarding Waiting Lists .. 2-113 Appendix M: Military Pay Stub Guidelines .. 2-115 Appendix N: Offer of Voter Registration Form .. 2-126 Appendix O: Change of Authorized Representative Form .. 2-128 Appendix P: Blood Work Requirements, Options, and Referrals.

10 2-130 Appendix Q: HANDS Pending Codes for Anthropometry and Bloodwork .. 2-136 Appendix R: Homeless Institutions and Referral List Guides .. 2-140 Appendix S: HANDS Termination Codes .. 2-147 2-150 Chapter Two Certification Arizona WIC Program Original: March 1997 Policy and Procedure Manual 2-8 Revision: June 2017 Overview Policy Individuals applying for participation in the Arizona WIC Program will be screened, using procedures outlined in this Chapter , to determine eligibility before they can be certified to participate. In This Chapter This Chapter is divided into nineteen (19) sections and fourteen (14) appendices, which detail the Certification process. Chapter Two Certification Arizona WIC Program Original: March 1997 Policy and Procedure Manual 2-9 Revision: June 2017 Section A Certification Guidelines Eligibility Determination The Local Agency staff determines if the applicant meets each of the following eligibility criteria: Residence Income Category Nutrition Risk All participants will be screened and Certified using the Health and Nutrition Delivery System (HANDS) automated system.