2023 Montana WIC State Plan

All policies are effective October 1, 2023

Please click on one of the following sections:


Affirmative Action Plan Methodology

Affirmative Action Table

Alternate Means for Signature of eWIC Card

Anemia Cut Off Values

Application for Local Agency Programs

Approved Food List

Blood Screening Procedures

Breastfeeding -Breast Pump Log

Breastfeeding - Multi-User Breast Pump Release Form

Breastfeeding -Single-User Breast Pump Release Form

Civil Rights Impact Analysis

Continuing Education Credit Approval Form

End of Certification and Notice of Ineligibility

eWIC Card Inventory Log

Formula Order Form

Formula Prescription Form

Formula Tracking Log

High-Risk Referrals

Homeless Facility Statement

Language Link Interpretive Service Guide

Language Link Point to Your Language Poster

Local Agency Location/Phone List

Local Agency Clinic Map

Minimum WIC Food Stocking Requirements

Monitoring - Breastfeeding Peer Counselor Program

Monitoring - Chart Review Areas Explained

Monitoring - Chart Review Form

Monitoring - Farmers Market Nutrition Program

Monitoring - Financial Questionnaire

Monitoring - On-Site Observations for Clinics

Monitoring - On-Site Observations for Appointments

Monitoring - Pre Visit Worksheet

Monitoring Process

Negative Income Statement

Nutrition Risk Code Table

Participant Rights and Responsibilities Statement

Program Compliance Form

Program Complaint Form - save form to computer before filling out to submit online

Reconstituted Amounts of Commonly Issued Formulas

Registered Dietitian Scope of Service for Agreements

Release of Information

Remote Registered Dietitian Scope of Service

Request for Hire

Tribal Eligibility Statement

Voter Registration Disclaimer

WIC Affidavit

WIC Memorandum of Understanding Disclaimer

WIC Organizational Chart

WIC System Access Form

Zero Income Statement