Minnesota Operations Manual (MOM)

1. SECTIONS

1.1 Introduction (PDF)

1.2 State WIC Staff and Role (PDF)

1.3 Local Agencies and Role (PDF)

1.4 Grant Application Process (PDF)

1.5 DELETED - Refer to 5.7 (PDF)

1.6 Public Notification and Outreach (PDF)

1.7 Data Privacy (PDF)

1.8 DELETED - Replaced by 9.2 (PDF)

1.9 Compliance Monitoring of Local Agencies (PDF)

1.10 Civil Rights (PDF)

1.11 Potential Participant Violations (PDF)

1.12 Termination/Suspension of Program Benefits (PDF)

1.13 Fair Hearing Procedure (PDF)

1.14 Records and Records Retention Requirements (PDF)

1.15 Electronic Signatures (PDF)

1.16 DELETED

1.17 Emergency Actions (PDF)

1.18 Separation of Duties to Assure Program Integrity (PDF)

1.19 Avoid Conflict of Interest to Assure Program Integrity (PDF)

1. EXHIBITS

1-C Authorization for Release of Information - Sample

• 1-C English (PDF)
• 1-C English (WORD)

1-C Autorización para la Divulgación de Información - Sample

• 1-C Spanish (PDF)
• 1-C Spanish (WORD)

1-D Sample Letter for Violation Threatening Harm (WORD)

1-H Authorization and Monitoring of WIC Vendors - State Role (PDF)

1-K Rights and Responsibilities

1-L Participant Violations - State Agency Role (PDF)

1-M Streamlined Certification Process for Emergency Situations (PDF)

1-N Request for Fair Hearing

• 1-N (PDF)
• 1-N (WORD)

1-O WIC Grant Application Process Overview (PDF)

1-P DELETED

1-Q Local Agency Internal Chart Review for One-Staff Certifications - Sample (WORD)

1-R Civil Rights Impact Analysis Survey (WORD)

2. SECTIONS

2.1 Introduction (PDF)

2.2 Financial Procedures (PDF)

2. EXHIBITS

2-C Request for Increase of Administrative Funds (PDF)

2-D WIC Costs Allowable and Unallowable (PDF)

2-F WIC Capital Equipment Inventory Log

• 2-F (PDF)
• 2-F (WORD)

3. SECTIONS

3.1 Introduction (PDF)

3.2 Processing Standards - Timeframes for Scheduling Certification Appointments (PDF)

3.3 Transferring Participants (PDF)

3.4 Waiting Lists (PDF)

NO EXHIBITS

4. SECTIONS

4.1 Introduction (PDF)

4.2 Local Agency Management (PD)

4.3 Competent Professional Authority (CPA) Qualifications and Responsibilities (PDF)

4.4 Breastfeeding Coordinator (PDF)

4.5 Staff Training (PDF)

4.6 CPA Monitoring and Oversight (PDF)

4.7 Designated Breastfeeding Expert (PDF)

4. EXHIBITS

4-A Local Agency Evaluation of Applicant Coursework (PDF)

4-B Sample Job Description for the WIC Designated Breastfeeding Expert (PDF)

4-F Topics for WIC Staff Breastfeeding Orientation (PDF)

4-G Staff Monitoring Plan (PDF)

4-H Checklist for Certification Observations (PDF)

4-J Chart Audit Form (PDF)

4-K Staffing Roles Grid (PDF)

4-L Written Plan for Local Agency to Complete Before Hiring a Paraprofessional CPA (PDF)

4-M Rubric for Assessment and Counseling Skills (PDF)

5. SECTIONS

5.1 Introduction (PDF)

5.2 Certification Procedures - all (PDF)

• 5.2 Certification Procedures (PDF)
• 5.2.1 Categories (PDF)
• 5.2.2 Residency (PDF)
• 5.2.3 Identity (PDF)
• 5.2.4 Income (PDF)
• 5.2.5 Physical Presence (PDF)

5.3 Nutritional Risk Assessment - all (PDF)

• 5.3 Nutrition Risk Assessment Overview (PDF)
• 5.3.1 Anthropometric Data (PDF)
• 5.3.2 Hematologic Assessment (PDF)
• 5.3.3 Health and Nutrition Information (PDF)
• 5.3.4 Nutrition Risk Code and Priority Assignment (PDF)

5.4 Notification of Ineligibility/Disqualification (PDF)

5.5 Change in Guardianship and/or Foster Care - Provision of WIC Services (PDF)

5.6 Homeless Applicants and Participants (PDF)

5.7 Referrals (PDF)

5.8 DELETED

5.9 Clinic Environment (PDF)

5.10 Mid-certification (PDF)

5. EXHIBITS

5-A Minnesota WIC Program Income Guidelines (PDF)

5-B Registers for Manual Signatures (WORD)

5-C Identification Requirements by WIC Contact Type (PDF)

5-K Documenting Clinic Scale Testing (PDF)

5-T Minnesota WIC Risk Criteria - HuBERT (PDF)

5-U Participant Priority System (PDF)

5-V Nutrition Risk and Priority Assignment Table - HuBERT (PDF)

5-W Homeless Facility Assessment Form (PDF)

5-Y Request for Medical Follow-up (PDF)

5-Y Request for Medical Follow-up (WORD)

5-AA WIC Clinic Assessment (PDF)

5-FF Welcome to WIC Handbook (PDF)

Sample Letter of Ineligibility

• 5-GG English (WORD)
• 5-GG Spanish (WORD)

5II1 Manual Certification - Infants and Children (PDF)

5II2 Manual Certification - Women (PDF)

5II3 Manual Certification - Proof of Eligibility (PDF)

6. SECTIONS

6.1 Introduction (PDF)

6.2 General Nutrition Education (PDF)

6.3 Initial Education (PDF)

6.4 Drug and Harmful Substance Use Education (PDF)

6.5 Breastfeeding Education for Pregnant Women (PDF)

6.6 High Risk Individual Nutrition Care Plans (PDF)

6.7 Additional Education (PDF)

6.8 Nutrition Education Documentation (PDF)

6.9 Nutrition Education Materials (PDF)

6.10 Local Agency Nutrition Education Plans (PDF)

6.11 Supporting Breastfeeding Through Breast Pump Access and Education on Expressing Milk (PDF)

6.12 Peer Breastfeeding Support (PDF)

6. EXHIBITS

6-A Minnesota WIC Program High Risk and Medical Referral Criteria (PDF)

6-G Breast Pump and Supplies Issuance and Inventory Log (WORD)

6-J Guidelines for Breastfeeding Peer Counselors to Yield to a Lactation Expert or Health Care Provider (PDF)

6-K Breastfeeding Peer Support Confidentiality Checklist and Agreement

• 6-K (PDF)
• 6-K (WORD)

6-L Sample Job Description for WIC Peer Counselor Manager

• 6-L (PDF)
• 6-L (WORD)

6-M Sample Peer Documentation Form

• 6-M (PDF)
• 6-M (WORD)

6-N Sample Peer Counselor Weekly Activity Report

• 6-N (PDF)
• 6-N (WORD)

7. SECTIONS

7.1 Introduction (PDF)

7.2 Allowed WIC Foods (PDF)

7.3 Food Package Assignment Overview (PDF)

7.4 Supporting Breastfeeding with the WIC Food Package (PDF)

7.5 WIC Formulas (PDF)

7.6 Medical Documentation (PDF)

7.7 Food Package 1 Infants 0-5 Months (PDF)

7.8 Food Package 2 Infants 6-11 Months (PDF)

7.9 Food Package 3 Infants, Women and Children with Qualifying Medical Conditions (PDF)

7.10 Food Package 4 Children 1 through 4 years (PDF)

7.11 Food Package 5 Pregnant and Mostly-Breastfeeding Women (PDF)

7.12 Food Package 6 Some-Breastfeeding and Nonbreastfeeding Postpartum Women (PDF)

7.13 Food Package 7 Fully Breastfeeding Women (PDF)

7.14 Food Package Options for Homeless Participants (PDF)

7. EXHIBITS

7-A Minimum Requirements for Supplemental Foods (PDF)

7-B WIC Formula Summary (PDF)

7-C Assessment of Infant Formula Feeding (PDF)

7-D MN WIC Program Request for Medical Formula (PDF)

7-E Authorization of Milk Substitute (PDF)

7-F Sample Formula Approval Letter (PDF)

7-G Sample Formula Denial Letter (PDF)

7-H Sample Letter Denying Pediasure (PDF)

7-I Returned Formula Log

• 7-I Fillable Form (WORD)
• 7-I for Print (WORD)

7-J Mom and Baby WIC Food Package (PDF)

7-K Standard Food Packages at a Glance - Children & Women (PDF)

7-L Undistributed Medical Formula Inventory Log (WORD)

8. SECTIONS

8.1 Introduction (PDF)

8.2 WIC Card Management: Ordering, Inventory & Security (PDF)

8.3 Issuing WIC Cards (PDF)

8.4 Issuing Food Benefits (PDF)

8.5 Replacing WIC Cards (PDF)

8. EXHIBITS

8-X MN WIC Card Inventory Log

• 8-X Fillable Form (WORD)
• 8-X for Print (WORD)

9. SECTIONS

9.1 Introduction (PDF)

9.2 WIC Information System (IS) (PDF)

9.3 Security of WIC Information System (PDF)

9.4 Equipment Inventory (PDF)

NO EXHIBITS