WIC Tools - Minnesota Department of Health

WIC Tools

Forms for Local Agencies and WIC Partners

MN WIC Program

Forms for MN WIC Local Agency Staff
HuBERT Forms - Local Agency Staff
Forms for Equipment/Supplies - Local Agency Staff
Forms for Vendors (Grocery Stores & Pharmacies
Forms for Other WIC Partners/Outreach

Forms for MN WIC Local Agency Staff

eWIC Transaction Issue Form (WORD)
A form to collect information if a participant has an eWIC transaction issue. Enough detail must be provided so MDH WIC staff can research the issue.

Questions/Feedback Form
Select any topic under WIC or HuBERT from the Topic drop-down. Enter your Local Agency Name in the appropriate field.

WIC Card Stock Order Form
Agencies should plan on maintaining at least 6 months of WIC Card stock. WIC Card orders are placed four times per year (quarterly): December 15th (1st quarter), March 15 (2nd), June 15th (3rd) and September 15th (4th). Shipments will be delivered about 6 weeks after the order deadline. No emergency shipments can be ordered. All agencies must submit quarterly orders. If no card stock is needed for that quarter, enter a 0 (zero) into the Number of Boxes field.

WIC Agency Materials Order Form
Quantities are based on packaging unit (ex: item ships in packs of 50; 1 = pack of 50). You can edit the quantity by scrolling to the Cart at the top of the page, hovering over the quantity number, and clicking the up/down arrow.

Medical Formula Order Form
Local Agencies can use this form to order medical formula from the State WIC Office.

Updated Monday, 13-Apr-2020 14:01:16 CDT