Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock (
) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
WIC Model Online Application Print Version (281.15 KB)
Spanish Translation of Model WIC Application (52.66 KB)
Jump to a Specific Section of the Model Application
Return to the WIC Online Application Toolkit
The following six sections, at a minimum, are recommended for WIC online applications based on research with WIC state and local agencies and WIC-eligible individuals. Including these sections, in this order, ensures that eligibility questions come first before applicants enter personal information. State agencies can customize their own applications to best meet their needs.
This section tells applicants what to expect.
Tips
"Start an application for [state agency] WIC"
Avoid jargon that is unfamiliar to applicants. If you use a term like "application," make it clear that a certification appointment is still needed before their application is complete.
"[State Agency]"
Replace [state agency] with the actual name of the state, territory, or Indian Tribal Organization (ITO) wherever it appears in this form.
"It should take about 5 minutes to complete."
Help applicants expect how long it should take to fill out this form.
"After you submit the form..."
Set expectations up front about the rest of the process. Customize this timeframe based on your state agency’s policy. State agencies are required to adhere to 7 CFR 246.7(f) following an applicant’s first request for benefits. Note whether they are calendar days or business days.
"Note: If you already use WIC and need help..."
Consider adding a link to find local clinic contact information. Research showed that some duplicate applications came from current WIC participants wanting to contact their local agency. This helps redirect them.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) helps eligible people with healthy foods, breastfeeding support, nutrition education, and referrals to local resources.
This form starts the application process for WIC. It should take about 5 minutes to complete. Apply for yourself, or on behalf of a child (this includes foster children).
Information to have when filling out this form:
After you submit the form, your local WIC clinic will contact you within [X] business days to schedule a virtual appointment to complete the application process.
Your information will remain secure and confidential.
Nondiscrimination statement | This institution is an equal opportunity provider
"Who counts in my household?"
Provide additional detail on what is considered a “household” for applicants. Applicants can be unsure of what falls under that term, so providing additional guidance either within the form itself or with a modal (or pop-up) window can help define the criteria.
Your household is everyone you live with and share income and expenses with. This includes children, people you aren’t related to, students away at school, and military service members even if they are away on active duty. If someone in your household is pregnant, you may increase your household size by one for each expected birth.
Foster children are considered separate households in WIC. Please complete one application for any foster children in your care and a separate application for any other household members (e.g., yourself and your children, children in your care). If you are not sure what your household size is, your local WIC clinic can provide more information.
This section helps applicants learn whether they are likely to be eligible for WIC in as few questions as possible. It should come before “Collect contact information” so applicants can check if they could be eligible before entering personal information.
For your application to show or hide screens based on the applicant's answer in real time, the software must be able to save data across screens.
Tips
"Do you live in [state agency]?"
ITOs should customize this question based on their service area to best reflect how they calculate residential eligibility.
"Continue"
Asking one question per page reduces the cognitive burden for applicants so they don’t have to answer a longer list of questions that may not apply. On the state agency side, it makes it easier implement the conditional logic and ideal user flow.
How to route an applicant
"Has had a baby..."
Avoid the term "postpartum," which is a specialized term not every applicant would know.
"Has had a pregnancy end..."
Use language that generalizes the experience but does not use triggering words like "miscarriage."
How to route an applicant
Required (Select all that apply):
Your household is everyone you live with and share income and expenses with. Learn who counts in your household.
Foster children are considered separate households in WIC. Please complete one application for any foster children in your care and a separate application for any other household members (e.g., yourself and your children, children in your care).
"[State agency]"
Replace [state agency] with the actual name of the state, territory, or Indian Tribal Organization (ITO) that is making and managing the form.
How to route an applicant
"...enrolled in any of the following programs?"
List the most common name and acronym for each benefit program. For example, this could be “SNAP (Supplemental Nutrition Assistance Program)” if your state hasn’t given it a state-specific name, but it could be “CalFresh” in California.
"Medicaid"
State agencies may need to rename the Medicaid option depending on how it’s funded. For example, different Medicaid programs may be available if they’re funded through Title 19.
How to route an applicant
If necessary
Check income eligibility if an applicant isn't adjunctively or automatically eligible
This section lets applicants check whether they are likely to be income-eligible if they aren’t adjunctively or automatically eligible through another program. This section should only be shown if they answered “None of these” for the previous question.
"How many people are in your household?"
Display the program definition of “household” where it’s relevant. This reduces confusion for the applicant.
Include income eligibility information for household sizes up to 16, which corresponds to the information included in the WIC income eligibility table.
“Is your total household income below the amounts in the following table?”
A table that shows the income threshold for their specific household size is easier for applicants to understand than a large table that shows all income thresholds at once. This question should be hidden until the applicant makes a selection in the previous question.
"If you are unsure about your income..."
Many eligible applicants on the cusp of the income threshold believe they are not eligible. WIC staff should be the final decision makers.
"Do not include income..."
Tribal payments received by local populations should be noted as exclusions from WIC income guidelines, according to policy.
How to route an applicant
All fields are required
You must be income-eligible to participate in WIC.
Your household is everyone you live with and share income and expenses with. This includes children, people you aren’t related to, students away at college, and military service members even if they are away on active duty. If someone in your household is pregnant, you may increase your household size by one for each expected birth.
If you are unsure about your income, select "I’m not sure." A WIC staff member can answer more specific questions about your situation when they follow up about your application.
Add up all sources of income, including:
Do not include income from loans, AmeriCorps, some military exceptions, or non-cash assistance.
| Annual max | Monthly max | Bi-weekly max | Weekly max |
|---|---|---|---|
| $57,720 | $4,810 | $2,220 | $1,110 |
"Military income exceptions"
To further define a "military exception, "consider linking additional information within a modal. This will keep the flow of the form fluid, and allow for more explanation when needed.
If your household includes a military service member, do not include income from combat pay, Basic Allowance for Housing (BAH), Overseas Continental United States Cost of Living Allowance (OCONUS COLA), Family Subsistence Supplemental Allowance (FSSA), Family Separation Housing (FSH), or Overseas Housing Allowance (OHA).
If necessary
This section tells applicants they are likely not eligible for WIC based on their responses and redirects them to other programs to find support.
"Based on your answers, you are likely not eligible for WIC"
Let the user know upfront to lessen confusion. If your software allows, create variations of this screen that explain why they may not be eligible, based on their responses.
"If you still think you may be eligible..."
Provide an opportunity for an applicant to get more clarification about their eligibility by calling the state agency or providing a link to a clinic locator.
"You can also visit [hyperlink] to learn about other assistance in [state agency]."
Give an applicant more opportunities to get help instead of just hitting a dead end.
You answered "None of these" to "Which of the following applies to you or someone in your household?" To receive WIC benefits in [state agency], one of the options must apply.
If you still think you may be eligible, please call [state agency] WIC at XXX-XXX-XXXX.
You can also visit [hyperlink] to learn more about other assistance in [state agency].
This section lets applicants fill in their contact information if they are likely eligible for WIC based on their answers.
This section contains PII. State agencies must follow all necessary security protocols to handle and store PII.
Tips
"Thank you! Based on your answers..."
Provide an indication that applicants are likely eligible at this point in the process. This can help them feel like including personal information is worth their time.
"Your legal name"
Use text entry fields that support many special characters, accents, and lengths. People can have names with punctuation or names with as few as two letters. This makes it easier for applicants without English names to apply.
"Date of birth"
Ask for the applicant’s date of birth to help your state agency locate existing application or MIS entries to prevent duplicates.
For more information on implementation and error validation check out the U.S. Web Design System (USWDS) pattern for date of birth.
"Your ZIP code"
Customize this field based on how your state agency routes applications to local agencies. It may be full address, county, a 5- or 9-digit ZIP code, etc.
If necessary
Add children's information
This section lets applicants add name and date of birth information for any eligible children. This page should only be shown if they said they have children under 5 years old in the earlier categorical eligibility question.
"How many children are in your household?"
The number selected in this dropdown should be the number of sections added to your form to hold information about each child.
Section
All fields are required
Add information for any children or foster children under 5 years old. All information must exactly match their proof of identity (i.e. birth certificate) you will provide the WIC office.
Complete a separate application for any foster children and for the rest of the household.
Enter their name as it is listed on the identification, not a nickname.
Enter their name as it is listed on the identification, not a nickname.
If necessary
Contact preference
If your agency doesn’t have multiple ways to contact applicants, don’t include this question.
"Contact preference"
Only include contact methods your agency uses to connect with applicants. Selecting "No preference" opts into all methods.
"Please select any preferred contact methods."
Provide relevant information to help applicants make their selections.
Only show the contact options that the user selected. For example, only include this question if a user selected they want to be reached by phone.
"...within [X] business days..."
Customize this timeframe based on your state agency’s policy. State agencies are required to adhere to 7 CFR 246.7(f) following an applicant’s first request for benefits. Note whether they are calendar days or business days.
"...8 a.m. to 12 p.m... 12 p.m. to 6 p.m."
State and local agencies may need to customize these time frames based on their operating hours.
"Can your clinic leave a voicemail?"
This question should only appear if an applicant selects telephone call as their contact preferences.
Not everyone has their own phone. Asking for permission to leave a voicemail respects an applicant’s privacy.
"Best number to text"
Applicants who share phones may prefer texting and calling from different numbers. Asking which number they prefer respects their privacy. It is a best practice to collect written permission to text.
All fields are required:
Your local WIC clinic will receive your information and will contact you within [X] business days to schedule an appointment.
If you share a phone and don’t want others to know about your application, please select no.
State agencies may choose to add additional questions to their online application in order to streamline the appointment. To learn more about these questions, reference the How to ask sensitive questions during WIC certification guide.
Tips
"You're almost done."
Let applicants know these questions will not impact their eligibility for WIC.
"Ethnicity and race"
This toolkit uses the race and ethnicity categories required by OMB standards prior to 3/29/2024, when the standards were revised. FNS will update this toolkit when guidance based on the revised race and ethnicity standards is available for WIC.
"We collect this information to..."
Asking applicants to share their race and ethnicity can feel confusing or invasive. Help them by explaining why WIC collects this information and how it will be used.
"Ethnicity"
Ask about the applicant’s ethnicity before asking about their race to reduce confusion.
"Select all that apply"
Make it clear if applicants can choose more than one option. If your MIS does not currently allow it, consider exploring if your state agency can update it to collect more than one response for race.
Section
There are a few more questions we’re required to ask you. Your answers will not impact your eligibility for WIC.
All fields are optional:
We collect this information to understand who WIC is serving and improve the program. Your answers do not impact your eligibility for WIC. You can read our non-discrimination notice here.
For example, "Black or African American" and "White"
"Voter registration"
State agencies may choose to include this question on an online application but would still need to share the state agency’s information form and voter registration form during the appointment. State agencies are encouraged to consult legal counsel and state election officials about handling voter registration assistance during WIC certification.
"If you are not registered to vote where you live..."
The National Voter Registration Act (NVRA) requires covered state agencies to use this specific wording to ask voter registration questions.
All fields are optional:
Benefit programs like WIC are required to help people register to vote. It’s okay if you do not want to or cannot register to vote. Your decision will not impact your eligibility for WIC or the benefits you will receive. If you choose to register to vote, the form and assistance will be provided during your appointment.
If you do not select either, you will be considered to have decided not to register to vote at this time.
"Understanding your voting rights..."
Consider using a modal to provide applicants with additional information.
"If you believe..."
The X should be filled in with the name, address, and telephone number of the appropriate official.
Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency.
If you would like help in filling out the voter registration application form, we will help you during your appointment. The decision whether to seek or accept help is yours. You may fill out the application form in private.
You may file a complaint with [X], if you believe someone has interfered with your rights to:
This section gives applicants the opportunity to correct any errors before submitting their form.
Tips
"If you want to make changes..."
Adjust the wording depending on your software’s features.
“Which of the following apply to you or someone in your household?
Use bullet points for questions that can have multiple responses.
Section
Review the information on this page before submitting. If you want to make changes, select "Edit" to go to the section you want to change.
Do you live in [state agency]?
YesEdit
Which of the following apply to you or someone in your household?
Have you or someone in your household received WIC benefits before?
NoEdit
Are you or someone in your household enrolled in any of the following programs?
Is your total household income below the amounts in the following table?
YesEdit
First or given name
ÁngelaEdit
Last or family name
SanchezEdit
Date of birth
01/01/2000Edit
Your ZIP code
12345Edit
How many children are in your household?
2Edit
First child
First or given name
CarlosEdit
Last or family name
SanchezEdit
Date of birth
10/19/2021Edit
Second child
First or given name
MariaEdit
Last or family name
SanchezEdit
Date of birth
09/20/2023Edit
Contact preference
Best number to call
(123) 456-7890Edit
When's the best time to call you?
Can your clinic leave a voicemail?
Yes, you may leave a voicemailEdit
Best number to text
(123) 456-7890Edit
Email address
angela.sanchez@email.comEdit
Ethnicity
Do you identify as Hispanic or Latino?
YesEdit
Race
Which of the following best describes you?
If you are not registered to vote where you live now, would you like to register to vote?
Yes, I want to register to voteEdit
Use this section to let applicants know their submission worked. This is also an opportunity to help them understand what to expect next.
Tips
"...within [X] business days..."
Make sure to save a date stamp with the form submission to track contact timeline.
"If you are in urgent need..."
Customize this phone number for your state agency to support applicants who need urgent assistance.
"Prepare for your appointment"
Provide applicants with information about what documents to prepare and what to expect at a certification appointment.
State agencies not widely offering virtual certifications yet may need to edit this language to fit their procedures.
If possible, send a reminder email or text before their appointment.
"Medicaid, TANF, or SNAP"
Customize this list based on program names within your state agency.
Section
You will hear from WIC staff within [X] business days to follow up on your application. If you are in urgent need of food or formula sooner, please call us at XXX-XXX-XXXX.
You'll need the following documents at your appointment:
If you can’t find your documents or have questions, a staff member will help you during your appointment.
At the appointment, we will review any proof documents and confirm eligibility for WIC. We will also talk with you about your and your children's health.
This section describes best practices for error states.
An error state indicates to an applicant that their answer is not valid.
Generally, only show an error state if a field is empty. Only validate further if the answer must be in a specific format. For example, if an email address is missing the @ symbol or if a phone number does not have 10 digits.
Show the error message next to the form field. That makes it easier for an applicant to tell which field they need to fix.
Tell the applicant how to fix the error. You can repeat part of the question, if relevant.
Enter your name as it is listed on the identification, not a nickname.
This section describes best practices for a modal (also called a pop-up or lightbox) which is a web page element that displays in front of other page content.
Research has shown that some terms, such as “household,” can be confusing to applicants. Linking terms within a modal window can help provide the space to further expand on definitions or guidance. This method can help users refer to additional information as needed, while not interrupting the flow of the form. Ensure that the website allows for modal implementation when using this component, otherwise look into another option like a tooltip or accordion.
Your household is everyone you live with and share income and expenses with. This includes children, people you aren’t related to, students away at school, and military service members even if they are away on active duty. If someone in your household is pregnant, you may increase your household size by one for each expected birth.
Foster children are considered separate households in WIC. Please complete one application for any foster children in your care and a separate application for any other household members (e.g., yourself and your children, children in your care). If you are not sure what your household size is, your local WIC clinic can provide more information.
