Get Wic Program Discrimination Follow-up Form

This guide provides a comprehensive and supportive overview of how to complete the WIC Program Discrimination Follow-Up Form online. Follow the step-by-step instructions to ensure accurate submission of your complaint related to discrimination.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the form and open it in an online editor.
2. Review the available options for the basis of discrimination. Select one or more categories that apply to the complainant's situation, including race, age, national origin, color, sex, or disability.
3. If the incident is reported to the local WIC agency, make a copy of the Program Integrity Screening Form and the Discrimination Follow-Up Form for agency records. Ensure the original copies are forwarded to the State WIC Office within five working days of receipt. Record the date sent and the name of the person sending it.
4. If the incident is reported to the State WIC Office, create a copy of the Program Integrity Screening Form and send it along with the follow-up form to the Civil Rights Director at the USDA Regional Office within five days of receiving the report. Be sure to write down the date sent and who sent it.
5. Send a copy of the Program Integrity Screening Form and the follow-up form to the State WIC Clinic Services Coordinator to log the incident in the Discrimination Log. Document the date sent and the name of the sender.
6. Log the details of the incident into the Discrimination Log. Make note of the date logged and who logged the information.
7. File the original copies of the forms into the Complaint File to maintain a record of the incident.
8. If additional follow-up is necessary, provide detailed notes in the space provided for further documentation and attach any supplementary materials.

Complete the WIC Program Discrimination Follow-Up Form online to ensure your concerns are addressed promptly.