WIC Income Forms

Download WIC Income Forms

  • WIC-19a - "Assistance Documentation Form"
    ° This form is to be used if your household has NO income, but receives assistance from family, friends, or an organization. THEY CANNOT LIVE IN THE SAME HOUSEHOLD!!
  • WIC-19b- "Employment Verification Form
    ° This form is to be used when you do not receive pay stubs and /or get paid in cash.
    ° This form must be completed by your employer and signed and dated.
    ° This form must also be signed by actual employee for release of information.
  • WIC-32- "Applicant's Statement of Farm/Self Employed"
    ° Complete Section A if the individual is self-employed. Complete Section B if the individual is self-employed farmer.