HuBERT Logo - Mama Loon with Baby Loon on Back

Resources & Forms


MN WIC Program

On this page:
HuBERT Forms
Formula Resources
References
Health Information Documentation Spreadsheet (EXCEL)

Related Topics:
2013 Request for Proposals - Archive
HuBERT Computer Specifications
HuBERT Performance Benchmarks
Local Agency Forms
Local Agency HuBERT Change Request Form
Memos
Technical Information


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.

Manual Certification - Infants and Children (Required Fields) (WORD)
For use if HuBERT system or Internet is down and cannot perform electronic certification - information for infants and children

Manual Certification - Women (Required Fields) (WORD)
For use if HuBERT system or Internet is down and cannot perform electronic certification - information for women

MN WIC Help Desk Feedback Form (WORD)
Please submit to Carol Rowe, Operations Unit Supervisor, at carol.rowe@state.mn.us

Rights & Responsibilities (Laminated Copy)
Link to WIC Materials Order Form for Local Agencies

WIC Household Food Instrument Register (WORD)
For use if staff cancel out of signature screen before participant can sign for benefits received

WIC Household Manual Certification Register (WORD)
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)
For use if HuBERT system or Internet is down and cannot perform electronic certification - household information

Back to Top


Formula Resources

MN WIC Contract Formula Amounts Guide (PDF) - updated June, 2015

Formula Amounts Guide for Medical Formula (PDF)

Formula Amounts Guide: Maximum Amounts by Federal Regulation (PDF)

Formula Resource Manual (PDF)

Back to Top


References

HuBERT Local Admin Functions (PDF)
Provides a brief overview of functionality in the System Administration module and Central Administrative Site module.

Back to Top