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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.