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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.
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