Applying for WIC

To apply for WIC benefits, you must fill out an application form at your local WIC clinic or download the forms by clicking HERE. You may also fill out an application for WIC and Medicaid at a Medicaid office or your prenatal clinic.

Your local WIC clinic staff will ask you for proof of identity, pregnancy (if needed), income, address, household size, immunization (for your infant or child under the age of five) and nutritional risk. To help determine nutritional risk and/or proof of pregnancy, you may be asked to fill out parts of the WIC Program Medical Referral Form. You will have to ask your doctor or health clinic staff to complete the remaining parts and return the form to the WIC clinic.

This is a checklist of documents and other items that you can use when you apply for WIC benefits. If you do not have or cannot get some of these items, WIC staff will tell you about others that can be used. You must bring at least one document from each section.

  • Proof of Residence- To prove where you live and who lives with you, you can use:
    • New York State Driver's License or Non-Driver Identification Card
    • Identification card with address
    • Lease letter or rent receipt from landlord
    • Bill (electric, heat, phone, credit card)
    • Letter or statement from a federal, state or local government agency (Social Security, Department of Social Services, military, etc.)
    • Paycheck or stub with home address
    • Bank statement
  • Proof of Category- To prove that you are pregnant or that your infant or child is under the age of five, you can use:
    • Completed WIC Program Medical Referral Form
    • Birth Certificate (for infant or child)
    • Confirmation of pregnancy
  • Proof of Income- To prove the amount of income you and your family earn, you can use:
    • Most recent pay stub
    • AFDC (Public Assistance) card
    • Food Stamps Card
    • Unemployment card
    • VOC Card
    • W-2 (Income Tax Statement of Wages and Earnings) form
    • Medicaid card or letter
    • Other documents (ask your WIC clinic staff)
    • Note: If you are a migrant worker or homeless, and cannot provide proof of the above, you can still apply for WIC.
  • Proof of Immunization- To prove that your infant or child under age 5 has received all recommended immunizations, you can use:
    • Immunization record card
    • Completed WIC Medical Referral Form, with immunization information attached.

Standards for participation in the WIC Program are the same for everyone

If you believe you have been discriminated against because of race, color, national origin, age, sex, or handicap, write immediately to:

Secretary of Agriculture
Washington, D.C. 20250

If you feel you have been discriminated against based on religion or political belief, call, toll-free, 1-800-522-5006

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