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Tennessee Health Department WIC Medical Request for Formula/Foods Patients Name: Date of Birth: REQUEST FOR ALTERNATE CONTRACT FORMULA Similac Advance (milkbased) and Similac Soy Isomil are provided.

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Their household income is at or below 250% of federal poverty level (FPL). For a family size of 2 that is $43,100 per year. For a family of four that is $65,500 per year.

Participants must be a Tennessee resident, meet the gross income guidelines and be determined to be at nutritional or medical risk.

Income Requirement To be eligible for WIC, applicants must have income at or below an income level or standard set by the state agency or be determined automatically income-eligible based on participation in certain programs.

Pregnant, or. Breastfeeding, or. Postpartum, or. A child 5 years old or younger.

Families can receive help from WIC no matter what their immigration status is. Undocumented immigrants can receive WIC as long as they live in California. Participants must meet WIC income guidelines. Check to see if you meet income guidelines by using the WIC Eligibility Assessment Calculator.

Can I use my WIC card to place an online or delivery order of WIC foods? No. The websites that allow customers to order groceries online are unable to accept WIC cards as a form of payment.

Find your local WIC agency, or call the Growing Up Healthy Hotline at 800-522-5006 and ask for the location nearest to you. Gather your income, residency, and identity documents to bring with you. Call the WIC agency where you wish to receive services and make an appointment.

Swipe your WIC Card the same way that you would with a debit or credit card. Your WIC nutritionist will help you select your food package every 1-3 months. Each month, your family's WIC food benefits will be deposited onto your card. Eligible food items you buy will subtract from your benefits total.

Visit www.signupwic.com to apply for benefits at your local WIC office.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232