Maine WIC Nutrition Program Policies

FFY2025 Policies

Breastfeeding Peer Counselor

• BFPC-1 Establishing BFPC Program (PDF)
• BFPC-2 BFPC Scope of Practice (PDF)
• BFPC-3 Training of Breastfeeding Peer Counselor (PDF)
• BFPC-4 Compensation (PDF)
• BFPC-5 BFPC Supervisor (PDF)
• BFPC-6 BFPC Supervisor Scope of Practice (PDF)
• BFPC-7 Referrals (PDF)
• Appendix BFPC-1-A BFPC Job Description (PDF)
• Appendix BFPC-2-A BFPC Activity Log and Monthly Report (Excel)
• Appendix BFPC-2-B Confidentiality Statement (PDF)
• Appendix BFPC-4-A Financial Report (Excel)
• Appendix BFPC-4-B BFPC Allowable Costs (PDF)
• Appendix BFPC-5-A BFPC Supervisor Job Description (PDF)
• Appendix BFPC-6-A BFPC Participant Survey Results Form (PDF)
• Appendix BFPC-7-A Moms Helping Moms (PDF)

Breastfeeding Support and Promotion

• BF-1 Breastfeeding Friendly Environment (PDF)
• BF-2 Staff Breastfeeding Promotion (PDF)
• BF-3 Breastfeeding Coordinator (PDF)
• BF-4 Breastfeeding Contacts (PDF)
• BF-5 Breastfeeding Food Packages (PDF)
• BF-6 Provision of Electric Breastpumps (PDF)
• BF-7 Manual Pumps and Breastfeeding Aids (PDF)
• BF-8 Breastfeeding Contraindications (PDF)
• Appendix BF-2-A IBCLC Referral Log (Excel)
• Appendix BF-6-A Electric Breastpump Agreement Form (PDF) | or as Word
• Appendix BF-6-B Loaner Pump Agreement Form (PDF)
• Appendix BF-6-C Rental Electric Breastpump Stop Payment (PDF)
• Appendix BF-6-D State Certified Letter for Loaner EBP Return (Word)
• Appendix BF-8-A American Academy of Pediatric Breastfeeding Statement (PDF)

Caseload Management

• CM-1 No Show (PDF)
• CM-2 Caseload Allocation of Services (PDF)
• CM-3 Community Outreach and Participant Retention (PDF)
• CM-4 Waiting List (PDF)
• Appendix CM-2-A Proposed Clinic Site Description Form (Excel)
• Appendix CM-3-A WIC Outreach Targets (PDF)
• Appendix CM-3-B_Outreach Tracking Log (Excel)

Certification and Eligibility

• CE-1 Eligibility Application (PDF)
• CE-2 Income Eligibility Determination and Documentation (PDF)
• CE-3 Nutrition Risk Determination (PDF)
• CE-4 Certification Periods (PDF)
• CE-5 Transfer of Certification and VOCs (PDF)
• CE-6 Processing Standards (PDF)
• Appendix CE-1-A WIC Participant Booklet (PDF)
• Appendix CE-1-B Scanned ID Authorization (PDF)
• Appendix CE-1-C Rights and Responsibilities Signature Page
• Appendix CE-2-A Income Eligibility Guidelines (PDF)
• Appendix CE-2-B Income Calculator (Excel)
• Appendix CE-2-C Declaration of Zero Income (PDF)
• Appendix CE-2-D Military Income Guide (PDF)
• Appendix CE-3-A Risk Factor Detail Guide (Excel)
• Appendix CE-3-B Refusal of Bloodwork (PDF)
• Appendix CE-3-C Release Nutrition Assessment (Word)
• Appendix CE-3-D Scale Calibration Instructions (PDF)
• Appendix CE-3-E Request for Information Infant and Child (PDF)
• Appendix CE-3-F Request for Information Women (PDF)
• Appendix CE-3-G Release HIV Status (Word)

Civil Rights

• CR-1 Public Notification (PDF)
• CR-2 Compliance (PDF)
• CR-3 Data Collection (PDF)
• CR-4 Complaint Process (PDF)
• CR-5 Training (PDF)
• CR-6 Language Access (PDF)
• CR-7 Special Populations (PDF)
• Appendix CR-4-A Civil Rights Log Template (Excel)
• Appendix CR-5-A Maine WIC Civil Rights Training Powerpoint (PPT)
• Appendix CR-5-B Maine WIC Civil Rights Training Facilitator Guide (PDF)
• Appendix CR-5-C Maine WIC Civil Rights Training Trainee Workbook (PDF)
• Appendix CR-5-D Maine WIC Civil Rights Training - Self-Paced (PDF)
• Appendix CR-5-E FNS Instruction for Civil Rights Compliance (PDF)
• Appendix CR-6-A Interpreter Sign (Word)
• Appendix CR-6-B Local Agency Interpreter Log (Excel)
• Appendix CR-7-A Language Accessibility Notice Tag Line (PDF)

Financial Management

• FM-1 State Agency Financial Management System (PDF)
• FM-2 State Agency WIC Expenditures and Drawdown Procedures (PDF)
• FM-3 State Agency Budget/Expenditure Plan (PDF)
• FM-4 State Agency Reporting Requirements (PDF)
• FM-5 Local Agency Funds Allocation and Budget Submission (PDF)
• FM-6 Local Agency Financial Management Systems (PDF)
• FM-7 State and Local Agency Access to Funds (PDF)
• FM-8 State and Local Agency Allowable Costs (PDF)
• FM-9 State and Local Agency Unallowable Costs (PDF)
• FM-10 Nutrition Education Costs (PDF)
• FM-11 Breastfeeding Promotion Costs (PDF)
• FM-12 Indirect Costs (PDF)
• FM-13 Shared (Allocable) Costs (PDF)
• FM-14 Program Income (PDF)
• FM-15 Local Agency Purchasing Procedures (PDF)
• FM-16 Property Management (PDF)
• FM-17 Participant Fees (PDF)
• FM-18 Cost Containment Measures (PDF)
• Appendix FM-4-A FNS-798 and Instructions (PDF)
• Appendix FM-4-B Financial Report SF-425 and Instructions (PDF)
• Appendix FM-5-A Cost Allocation Plan (PDF)
• Appendix FM-6-A Quarterly Financial Report (Excel)
• Appendix FM-8-A Allowable and Unallowable Costs (PDF)
• Appendix FM-10-A Food Purchase Log (Excel)
• Appendix FM-15-A Equipment Log and Inventory (Excel)

Farmer Market Nutrition Program

• FMNP-1 Farmer Selection and Authorization (PDF)
• FMNP-2 Farmer Training (PDF)
• FMNP-3 High Risk Farmer Identification Systems (PDF)
• FMNP-4 Farmer Monitoring (PDF)
• FMNP-5 Farmer Sanction System (PDF)
• FMNP-6 Administrative Review of State Agency Actions for Farmers (PDF)
• FMNP-7 Farmer Operations (PDF)
• FMNP-8 Local Agency Administration of WIC FMNP (PDF)
• Appendix FMNP-1-A Farmer Agreement (PDF)

Food Delivery

• FD-1 Food Delivery System Overview (PDF)
• FD-2 Food Benefits Pick-Up and Transaction (PDF)
• FD-3 Food Benefit Redemption and Disposition (PDF)
• FD-5 Proxy Assignment (PDF)
• FD-6 Return of Formula (PDF)
• Appendix FD-2-A Card Issuance Form (PDF)
• Appendix FD-3-A WIC Benefit Replacement Form (PDF)
• Appendix FD-7-A Formula Returned Log (Excel)

Information Systems

• IS-1 System Planning and Operations (PDF)
• IS-2 Participant Characteristics Minimum Data Set (PDF)
• IS-3 Functional Requirements Checklist (PDF)
• IS-4 Data Security (PDF)
• IS-5 Local Agency IT Requirements (PDF)
• Appendix IS-4-A Data Inventory Form (PDF)
• Appendix IS-4-B Data Use Plan (PDF)
• Appendix IS-4-C Release Unrestricted Data Request (PDF)

Monitoring and Audits

• MA-1 State and Local Agency Audits (PDF)
• MA-2 Monitoring (PDF)
• Appendix MA-2-A MER Form (Excel)
• Appendix MA-2-B Annual Report Template (Word)

Nutrition Services

• NS-1 Nutrition Counseling (PDF)
• NS-2 Food Package Design (PDF)
• NS-3 Value Enhanced Nutrition Assessment (PDF)
• NS-4 Nutrition Coordinator (PDF)
• NS-5 Nutrition Services Referrals (PDF)
• NS-6 Medical High Risk (PDF)
• Appendix NS-1-A Infant Nutrition Guidance (PDF)
• Appendix NS-1-B Child Nutrition Guidance (PDF)
• Appendix NS-1-C Woman Nutrition Guidance (PDF)
• Appendix NS-1-D WIC Appointment Quick Reference Guide
• Appendix NS-2-A Food Package Design (PDF)
• Appendix NS-2-D Formula Reconstitution Monthly Maximum (Excel)
• Appendix NS-2-F Decision Cube Draft (PDF)
• Appendix NS-2-G Medical Formula Rx Form (PDF)
• Appendix NS-2-H Release Special Formula Prescriptions (PDF)
• Appendix NS-2-I Fax Coversheet GHS PA Form (PDF)
• Appendix NS-2-K Troubleshooting Formula Access (PDF)
• Appendix NS-3-A VENA Competency Table (PDF)
• Appendix NS-4-A Medical Formula Log (Excel)
• Appendix NS-6-A Medical High Risk Log (Excel)

Organization and Management

• OM-1 State Staffing (PDF)
• OM-2 Selection of Local Agencies (PDF)
• OM-3 Local Agency Disqualification (PDF)
• OM-4 Local Agency Staffing (PDF)
• OM-5 Disaster Recovery (PDF)
• OM-6 Employee Fraud and Abuse (PDF)
• OM-7 Participant Fraud and Abuse (PDF)
• OM-8 Parental and Custodial Rights (PDF)
• OM-9 Dual Participation (PDF)
• OM-10 Participant Rights and Responsibilities (PDF)
• OM-11 Media Relations (PDF)
• OM-12 Staff Training and Continuing Education Requirements (PDF)
• OM-13 Community Provider Agreements (PDF)
• OM-14 Mandated Reporting (PDF)
• OM-15 Confidentiality and Privacy (PDF)
• OM-16 Fair Hearings (PDF)
• OM-17 Travel (PDF)
• OM-18 WIC Acronym (PDF)
• OM-19 Dietetic Intern Requests (PDF)
• OM-20 Occupational Exposure (PDF)
• OM-21 State Plan Notice (PDF)
• Appendix OM-1-A WIC State Agency Organization Chart (PDF)
• Appendix OM-4-A Employee Information Form (PDF)
• Appendix OM-6-A Separation of Duties File Review Form (Excel)
• Appendix OM-7-A Sample Formula Sale Letter (Word)
• Appendix OM-7-B Sample Participant Abuse Letter (Word)
• Appendix OM-7-C Repayment Agreement Form (PDF)
• Appendix OM-8-A Sample Custody Change Letter (Word)
• Appendix OM-12-A Time Study Training (PDF)
• Appendix OM-12-B Employee Conflict of Interest Statement (PDF)
• Appendix OM-12-C Continuing Education Log (Excel)
• Appendix OM-13-A Residential Facility Form for Local Agency Staff (Word)
• Appendix OM-14-A Mandated Reporter Worksheet (PDF)
• Appendix OM-15-A Health Information, Privacy and Security - Minimum Necessary (PDF)
• Appendix OM-15-B Health Information, Privacy and Security - HIPAA Uses and Disclosures (PDF)
• Appendix OM-15-C HIPAA Uses and Disclosures of Protected Health Information (PDF)
• Appendix OM-15-D HIV AIDS Confidentiality of Information (PDF)
• Appendix OM-15-E Confidentiality Agreement (PDF)
• Appendix OM-16-A Notification of Appeal Procedures (PDF)
• Appendix OM-16-B Fair Administrative Hearing Request Form (PDF)
• Appendix OM-19-A Sample Consent Form for Interns (Word)

Vendor Management

• VM-1 Vendor Selection and Authorization (PDF)
• VM-2 Vendor Training (PDF)
• VM-3 High-Risk Vendor Identification Systems (PDF)
• VM-4 Routine Monitoring (PDF)
• VM-5 Compliance Investigations (PDF)
• VM-6 Vendor Sanction System (PDF)
• VM-7 Administrative Review of State Agency Actions (PDF)
• VM-8 Coordination with the Supplemental Nutrition Assistance Program (SNAP) (PDF)
• VM-9 Staff Training on Vendor Management (PDF)
• VM-10 Confidentiality of Vendor and SNAP Retailer Information (PDF)
• VM-11 Vendor Price Lists (PDF)
• VM-12 Vendor Operations (PDF)
• VM-13 Conflict of Interest (PDF)
• VM-14 Vendor Claims (PDF)
• Appendix VM-1-A Minimum Inventory Requirements (PDF)
• Appendix VM-1-B Infant Formula Authorized List (PDF)
• Appendix VM-1-C Vendor Agreement (PDF)
• Appendix VM-1-D Vendor Application (PDF)
• Appendix VM-1-E_Maine Request for Application (PDF)
• Appendix VM-2-A WIC Vendor Training Log (PDF)
• Appendix VM-2-B Vendor Interactive Training Attended (PDF)
• Appendix VM-2-C Vendor Training Guide (PDF)
• Appendix VM-4-A On-Site Monitoring (PDF)
• Appendix VM-5-A Compliance Buys Reporting Form (PDF)
• Appendix VM-5-B Compliance Buy Card Log (PDF)
• Appendix VM-7-A Administrative Hearing Request Form (PDF)

Questions?

Contact the WIC Team:

• Contact us online form
• Phone:
  • (207) 287-3991
  • 1-800-437-9300
• E-mail:
  • State Agency: [email protected]
  • Vendor: [email protected]