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Resources & FormsMN WIC Program |
- HuBERT Forms
- Local Agency Forms (Links to Another Page)
- Local Agency HuBERT Change Request Form (Links to Another Page)
- Formula Resources
- Memos (Links to Another Page)
- References
- Reports (Links to Another Page)
- Technical Information (Links to Another Page)
- Health Information Documentation Spreadsheet (EXCEL: 25KB/1 page)
HuBERT Forms
- Local Agency HuBERT Change Request Form
Use to submit suggestions for HuBERT software changes, drop-down list options, nutrition education topics/materials; to add/update/remove medical home clinics, referral organizations and WIC clinics; and request assistance with ad-hoc reporting. - Rights & Responsibilities (Laminated Copy)
Link to WIC Materials Order Form for Local Agencies - WIC Household Food Instrument Register (WORD: 73.8KB/1 page)
For use if staff cancel out of signature screen before participant can sign for benefits received - WIC Household Manual Certification Register (WORD: 87.5KB/1 page)
For use if staff cancel out of signature screen before participant can sign for Rights & Responsibilities or before staff can sign for having determined eligibility - WIC Proof of Eligibility - Manual Certification (WORD: 86.5KB/1 page)
For use if HuBERT system or Internet is down and cannot perform electronic certification - household information - Manual Certification - Women (Required Fields) (WORD: 150KB/3 pages) - revised 1/24/11
For use if HuBERT system or Internet is down and cannot perform electronic certification - information for women - Manual Certification - Infants and Children (Required Fields) (WORD: 118KB/2 pages) - revised 1/24/11
For use if HuBERT system or Internet is down and cannot perform electronic certification - information for infants and children - MN WIC Help Desk Feedback Form (WORD: 37KB/1 page)
Please submit to Carol Rowe, Operations Unit Supervisor, at carol.rowe@state.mn.us
Formula Resources
- MN WIC Contract Formula Amounts Guide (PDF: 25KB/1 page)
- Formula Amounts Guide for Medical Formula (PDF: 128KB/13 pages)
- Formula Amounts Guide: Maximum Amounts by Federal Regulation (PDF: 66KB/1 page)
- Formula Resource Manual (WORD: 786KB/149 pages)
References
- Referral Organizations (EXCEL: 559KB/87 pages)
- How to Sort Referrals List by Agency ID (PDF: 540KB/3 pages)
- HuBERT Potential Enhancements List - January 2012 (PDF: 98KB/8 pages)
- Known HuBERT Issues/Bug List - 04/01/2011 (PDF: 66KB/4 pages)
- HuBERT Grantee, Agency, and Clinic IDs - 08/01/2012 (PDF: 92KB/6 pages)
- HuBERT LSA functions (System Administration and Central Administrative Site) - 06/29/11 (PDF: 738KB/29 pages)
