WIC is a federal government program funded by the U.S. To request a copy of the complaint form, call (866) 632-9992.The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides healthcare and nutrition to low-income pregnant women, breastfeeding women, and children under age five. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at: and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. Additionally, program information may be made available in languages other than English. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Persons with disabilities who require alternative means of communication for program information (e.g. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. In accordance with Federal civil rights law and U.S. Immunization Record(s) for all infants and children up to age 2 years who are applying for WIC You may automatically be income eligible if you or certain family members participate in Medicaid, Temporary Assistance for Needy Families (TANF), or SNAP.

Unemployment or worker’s compensation statement.

Award letter for alimony, child support, social security (including SSI).

Paycheck stub(s) for the past 30 days if paid biweekly, bring 2 pay stubs or, if paid weekly, bring 4 pay stubs.

Proof of Income – Income documents for everyone in your household who works or has a source of income

Bill or business letter addressed to you.

Proof of Identity for yourself and each person who is applying for WIC

A parent, guardian, or caretaker of an infant or child who is applying for WIC

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