Participant Obligations & Consent

As a WIC Program participant, you are responsible for:

• Keeping all appointments, or notifying the clinic ahead of time to reschedule appointments that you are unable to keep.

• Making sure you do not participate in two or more WIC Programs at the same time.

• Allowing WIC clinic staff to secure height, weight, blood work, and other measurements, as necessary.

• Following the guidelines set for obtaining and using the foods made available by the Program.

• If checks are not picked up for two consecutive cycles, you are automatically terminated from the program. You must reapply for WIC.

WIC Participants consent to the following statements upon enrollment in the program:

• “I hereby consent to participate in the Program and agree with the responsibilities of participation.”

• “I understand that my participation in more than one WIC Program at the same time is illegal. Failure to comply will result in suspension from the Program”.

• “I have been advised of my rights and obligations under the Program. I certify that the information I have provided for my eligibility determination is correct, to the best of my knowledge. Program officials may verify the information submitted.”

• “I understand that intentionally making a false or misleading statement or intentionally misrepresenting, concealing, or withholding facts may result in my paying the State Agency the cash value of the food benefits improperly issued to me, and may subject me to civil criminal prosecution under District of Columbia and Federal law”.

• “I understand that the WIC Program may share certification information with other government agencies, such as (but not limited to) the Division of Immunization, the Office of Maternal and Child Health, Healthy Start, and the Medicaid and Food Stamp Programs in order to help the participant obtain other services, including childhood immunizations and prenatal care.