WIC: Electronic and Available to Order

 Forms, Publications, and Other Documents

Below is a list of all WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) documents including electronic only and printed items available to order. Review the "Available to Order" column below to ensure availability in paper format. If the document is available to order in a paper version, there will be a "Yes" with a link to ordering instructions.

When you are searching for a document, enter the number or a portion of the title in the search box below. To narrow your search results even more, place quotation marks " " around search terms. For example: "Breastfeeding Peer Counselors"

Ordering instructions for local WIC agencies only:

  • Download and fill out the Forms/Publications Order, F-80025A. Order only as many as you will use in three to six months. For most items you should order in quantities of at least 50.
  • Email the completed order form to the WIC forms processor at dhsfmdphwic@dhs.wisconsin.gov. You will receive a confirmation email once your order has been processed.
Assigned Number Title Sort descending Release Date File Type Language Available to Order
P-00270 Instructions Related to 276/277 Health Care Claim Status Transactions Based on ASC X12 Manual 05/2015 PDF English
P-00293 Instructions Related to 278 Health Care Services Review - Request for Review and Response (278) Transactions Based on ASC X12 Implementation Guide 10/2015 PDF English
P-00262 Instructions Related to 820 Health Care Payroll Deducted and Other Group Premium Payment Manual 07/2023 PDF English
P-00262 Instructions Related to 820 Health Care Payroll Deducted and Other Group Premium Payment Manual (Effective for dates before August 13, 2023) 07/2023 PDF English
P-00264 Instructions Related to 834 Benefit Enrollment and Maintenance (834) Based on ASC X12 Implementation Guide 03/2019 PDF English
P-00271 Instructions Related to 835 Health Care Claim Payment/Advice Based on ASC X12 Manual 06/2014 PDF English
P-00263 Instructions Related to 837 Health Care Claim/Encounter: Dental (837D) Transactions Based on ASC X12 Implementation Guide 12/2018 PDF English
P-00266 Instructions Related to 837 Health Care Claim/Encounter: Institutional (837I) Transactions Based on ASC X12 Implementation Guide 07/2016 PDF English
P-00266 Instructions Related to 837 Health Care Claim/Encounter: Institutional (837I) Transactions Based on ASC X12 Implementation Guide 07/2015 PDF English
P-00265 Instructions Related to 837 Health Care Claim/Encounter: Professional (837P) Transactions Based on ASC X12 Implementation Guide 12/2018 PDF English
P-00268 Instructions Related to 999 Acknowledgement for Health Care Insurance Based on ASC X12 Manual 01/2012 PDF English
P-00269 Instructions Related to TA1 Interchange Acknowledgement Based on ASC X12 Manual 06/2011 PDF English
F-00202I Instructions – Individual Service Plan – Community Recovery Services (CRS) 08/2016 PDF English
F-00107 Instructions, Self-Employment Income Report 06/2019 PDF English
F-00107ACM Instructions, Self-Employment Income Report, Chinese (Simplified) 06/2019 PDF Chinese (Simplified)
F-00107 Instructions, Self-Employment Income Report, Hmong 06/2019 PDF Hmong
F-00107 Instructions, Self-Employment Income Report, Spanish 06/2019 PDF Spanish
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records 02/2017 PDF English
F-00634 Instructions-County Birth to 3 Program Annual Notification of Parental Rights Regarding Records, Spanish 02/2017 PDF Spanish
F-02717A Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification 04/2023 PDF English
F-02717AH Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Hmong 04/2023 PDF Hmong
F-02717AS Instructions: Electronic Visit Verification (EVV) Live-in Worker Identification, Spanish 04/2023 PDF Spanish
F-01234A Instructions: Explanation of Medical Benefits 11/2023 PDF English
F-16030B Instructions: FoodShare Wisconsin Overpayment Calculator 01/2018 PDF English
F-02382I Instructions: HCBS Heightened Scrutiny Residential Provider Evidentiary Worksheet 10/2020 PDF English

Glossary

 
Last revised August 16, 2024