This chapter specifies the eligibility policies and procedures and the benefits available under the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program or Program) operated by the Maryland Department of Health, with funding substantially provided by the United States Department of Agriculture (USDA) under the Child Nutrition Act of 1966, §17, as amended. The WIC Program provides supplemental foods and nutrition education, including breastfeeding promotion and support: Through local agencies at no cost to eligible individuals; and To pregnant women, postpartum women, breastfeeding women, infants, and children, who are from families with income below a certain established amount and who are determined by a competent professional authority or a competent paraprofessional authority to be at risk with respect to their physical and mental health by reason of inadequate nutrition or health care, or both. The WIC Program serves as an adjunct to good health care during critical times of growth and development in order to prevent health problems and improve the health status of participants. In this chapter, the following are incorporated by reference: 42 U.S.C. §1786, as amended; 7 CFR 246, as amended; and 7 CFR 15, 15a, and 15b, as amended. In this chapter, the following terms have the meanings indicated. Terms Defined. “Applicant” means an individual who has requested or on whose behalf another person has requested WIC benefits in person, either orally or in writing, under the provisions of this chapter. “Benefits” means the foods prescribed and services provided to a participant by the Program. “Breastfeeding woman” means a woman up to 1 year postpartum who is breastfeeding her infant. “Caretaker” means an individual who is responsible for the care and welfare of a participant. “Caseload” means the participation level that is assigned to a local agency by the State agency. “Certification” means the implementation of criteria and procedures to assess and document an applicant's eligibility for the Program. “Certification period” means the time period for which a participant has been authorized by a local agency as eligible for Program benefits. “Child” means an individual who is 1 year old or older but is younger than 5 years old. “Clinic” means a local agency facility where an applicant is certified. “Competent paraprofessional authority” means an individual who: Does not meet the definition of a competent professional authority; Successfully completes a WIC training program approved by the State agency; and Performs certifications under the supervision of a competent professional authority. Competent Professional Authority. “Competent professional authority” means an individual who is a: Physician; Nutritionist; Dietitian; Registered nurse; Physician's assistant certified by the National Committee on Certification of Physician's Assistants or certified by the State Board of Physician Quality Assurance; or State or local medically trained health official. “Competent professional authority” includes an individual who is: On the staff of the local agency and authorized by the State agency to serve as a competent professional authority; or Not on the staff of the local agency, but who is qualified to provide data upon which a nutritional risk determination is made by a competent professional authority on the staff of the local agency. “Complementary feeding process” means a nutrition risk that applies to an infant or a child from 4 through 23 months old who has begun to or is expected to begin to: Consume foods or beverages complementary to breast feeding; Eat independently; Be weaned from breast milk or infant formula; or Transition from a diet specifically intended for infants or toddlers to one based on the Dietary Guidelines for Americans, as updated every 5 years by the United States Department of Agriculture with the United States Department of Health and Human Services under Title III of Public Law 101-445 of the National Nutrition Monitoring and Related Research Act of 1990. “Day” means a calendar day. “Disqualification” means the act of ending the Program participation of a participant, whether as a punitive sanction or for administrative reasons. “Dual participation” means an individual's simultaneous participation in the WIC Program in more than one state, local agency, or clinic, or participation in the WIC Program and in the Commodity Supplemental Food Program funded by the USDA during the same period of time. “Family” means a group of related or nonrelated individuals who are not residents of an institution but who are living together as one economic unit, except that residents of a homeless facility or an institution may not all be considered as members of a single family. “Food delivery system” means the method used by a local agency to provide supplemental foods to a participant. “Food instrument” means an electronic benefits transfer (EBT) card or other document that is used by a participant to obtain supplemental foods. “Health services” means ongoing, routine, pediatric, and obstetric care or referral for treatment. “HHS” means the United States Department of Health and Human Services. Income. “Income” means gross cash income before deductions for: Income taxes; An employee's Social Security taxes; Insurance premiums; Bonds; Housing subsidy in the form of cash or stipend; or Cash food subsidy. “Income” includes: Monetary compensation for services, including wages, salary, commissions, or fees; Net income from farm and nonfarm self-employment; Social Security benefits; Dividends or interest on savings or bonds, income from estates or trusts, or net rental income; Public assistance or welfare payments; Unemployment compensation; Government civilian employee or military retirement pensions, or veterans' payments; Private pensions or annuities; Alimony or child support payments; Regular contributions from individuals not living in the household; Net royalties; Other cash income, which includes, but is not limited to, cash amounts received or withdrawn from any source including savings, investments, trust accounts, and other resources that are readily available to the applicant or the applicant's family; or Cash contributions from others residing in the same living quarters as the applicant. “Income” does not include payments or benefits excluded under 7 CFR §246.7(d)(2)(iv). “Infant” means an individual younger than 1 year old. “Instream migrant” means a migrant farm worker or an individual accompanying a migrant farm worker who is traveling and currently employed or seeking employment in seasonal agricultural work that causes the migrant to move from the migrant's home. “Local agency” means a public or private, nonprofit health or human service agency that provides health services, either directly or through contract. “Migrant farm worker” means an individual: Whose principal employment is in agriculture on a seasonal basis; Who has been employed in agriculture on a seasonal basis within the last 24 months; and Who establishes, for the purpose of employment in agriculture on a seasonal basis, a temporary home. “Nutritional risk” means: Detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric measurements; Other documented nutritionally related medical conditions; Dietary deficiencies that impair or endanger health; Conditions that directly affect the nutritional health of an individual, including alcoholism or drug abuse; or Conditions that predispose individuals to inadequate nutritional patterns or nutritionally related medical conditions, including but not limited to homelessness and migrancy. “Nutrition education” means individual or group education sessions and the provision of information and educational materials designed to improve health status, achieve positive change in dietary and physical activity habits, and emphasize relationships between nutrition, physical activity, and health, all in keeping with the individual's personal and cultural preferences. “Nutritionist” means an individual licensed in Maryland who has a bachelor's or master's degree in nutritional sciences, community nutrition, clinical nutrition, dietetics, public health nutrition, or home economics with an emphasis in nutrition. “Participant” means a pregnant woman, breastfeeding woman, postpartum woman, infant, or child who is receiving benefits under the Program, and the breastfed infant of a breastfeeding woman participant. “Participation” means receiving benefits under the Program. “Participation data” means information concerning the number of: Individuals who received benefits during a reporting period; Infants who received no benefits during a reporting period, but who were breastfed by participant breastfeeding women; and Breastfeeding women who did not receive benefits but whose infant received benefits during the reporting period. “Postpartum woman” means a woman up to 6 months after the termination of her pregnancy. “Poverty income guidelines” means the poverty income guidelines prescribed and adjusted annually by HHS. “Pregnant woman” means a woman who is determined to have one or more embryos or fetuses in utero. “Program” means the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorized by 42 U.S.C. §1786, the Child Nutrition Act of 1966, as amended. “Proxy” means an individual who is designated by a participant or a child or infant participant’s parent, guardian, or caretaker to receive food instruments and to redeem food benefits for the participant and whose name is on file at the local agency. “Special nutritional risk applicant” means a migrant farmworker or a migrant farmworker's family, a pregnant woman, or an infant. “State agency” means the Maryland Department of Health's WIC Program. “Supplemental foods" means those foods containing nutrients determined to be beneficial for a pregnant woman, breastfeeding woman, postpartum woman, infant, or child, as prescribed by the Secretary of the USDA under 7 CFR §246.10, which is incorporated by reference in Regulation .03 of this chapter. “USDA” means the United States Department of Agriculture. “Verification of certification” means a document that provides proof of Program eligibility for the participant who is transferring from one WIC agency to another. An applicant shall be certified as eligible before participating in the Program. To be certified as eligible for the Program, an infant, a child, or a pregnant, postpartum, or breastfeeding woman: Shall reside, without regard to the length of residency, within the jurisdiction of: Maryland, unless a reciprocal agreement has been established with another State agency; and The local agency as defined by the State agency; Shall present documentation of identity for the application for benefits; Shall be determined by the local agency to be income eligible pursuant to the specifications set forth in Regulation .07 of this chapter; Shall be at nutritional risk pursuant to the specifications set forth in Regulation .08 of this chapter; and May not engage in dual participation. In order to be eligible for WIC benefits, an applicant shall provide to a local agency documentation of Maryland residency, or residency in a state having a reciprocal residency agreement with Maryland. Documentation. In order to document residency, an applicant shall provide to the local agency one of the following: Dated correspondence documenting the applicant’s home address; Maryland driver's license or identification card; In the case of an applicant who was a prior participant, documentation that the applicant still resides at the same address that is on file with the WIC Program; or Another item that confirms the residency of the applicant. Recording of Residency Documentation. A local agency shall document proof of residency. Determining Income. In order to determine whether an applicant is income-eligible for Program participation, a local agency shall determine the applicant's income, which is determined pursuant to family size as set forth in §B of this regulation. Subject to the provisions of this regulation, a local agency shall determine an applicant’s income by adding together the sources of income for an applicant and the applicant’s family. In determining an applicant’s family income, a local agency shall consider the family’s income to be the more accurate figure between the family’s income for the previous 12 months or the family’s current rate of income for the last 30 days. If an applicant meets the income eligibility guidelines, a local agency shall declare the applicant income-eligible for WIC benefits based on the applicant's family income. An applicant shall provide to the local agency documentation of the applicant's family income, as set forth in §E of this regulation. In order to determine whether an applicant is income-eligible for Program participation, a local agency shall determine the size of the applicant's family according to the following: In the case of a pregnant woman, the unborn child or children are counted only if this action allows the woman to meet income eligibility standards; An infant or child is counted in the family size of the parent, caretaker, or guardian with whom the infant or child resides; An infant, child, or other family member residing in a school or institution is counted in the family size of the parent, caretaker, or guardian who is providing economic support for that infant, child, or family member; An infant or child who is a foster child living with a family, but who remains the legal responsibility of a welfare or other agency, is counted as a family of one and payments made by the agency or other sources to the family for the care of that foster child are the income of that foster child; and An adopted child or individual for whom a family member has accepted legal responsibility is counted in the family size for that family with whom the individual resides. Recording of Income Information. A local agency shall document proof of income. If an applicant claims to have no income, the applicant shall complete the form provided by the State agency declaring zero income. Determining Income Eligibility. After a local agency has recorded the family size information of an applicant, the local agency shall determine whether the applicant is income-eligible for Program participation. To be considered eligible for the Program, an applicant and the applicant’s family shall have a gross income that is less than or equal to 185 percent of the poverty income guidelines issued by HHS, or shall provide documentation that the applicant is a recipient of: Food stamps under the Food Stamp Act of 1977; Benefits under Maryland's Temporary Cash Assistance program established under Part A of Title IV of the Social Security Act; Medical Assistance Program under Title XIX of the Social Security Act; or Another State-administered program that routinely requires documentation of income, if the program has income eligibility guidelines at or below the WIC Program's income guidelines. A local agency shall determine an applicant to be automatically income-eligible for the WIC Program if a member of the applicant’s family is: Receiving benefits under Maryland's Temporary Cash Assistance program; or A pregnant woman or an infant currently participating in the Medical Assistance Program under Title XIX of the Social Security Act. A local agency shall use the current poverty income guidelines issued by HHS and transmitted by the State agency in determining applicant eligibility. The State agency shall adjust the Program income eligibility guidelines annually at the time the State implements income eligibility guidelines under the Medical Assistance Program. Instream Migrant Farm Worker. A local agency shall consider that: An instream migrant farm worker applicant or the family of an instream migrant farm worker applicant with an expired verification of certification is income-eligible for Program certification if the instream migrant farm worker’s family income was determined at least once within the past 12 months; and A member of an instream migrant farm worker family is income-eligible for Program certification if the income criteria was met either in the migrant's home state before the migrant entered the stream for a particular agricultural season or in an instream area during the agricultural season. Documentation of Income. An applicant shall provide to the local agency documentation of the applicant's family income. Except as provided in §E(3) of this regulation, a local agency shall accept any of the following as documentation of income: Pay stubs; Income tax returns; W-2 forms; Forms showing eligibility or benefit levels; and Documents confirming participation in another State-administered program whose income eligibility guidelines are less than or equal to the WIC Program's income eligibility guidelines. If an applicant cannot provide a document cited in §E(2) of this regulation, a local agency may confirm the applicant's participation in another State-administered program by telephoning the appropriate staff person of that program and documenting the telephone contact in the applicant's record. A local agency shall deny Program participation to an applicant who fails to provide income documentation within 30 days of the date that the individual applied for Program benefits. After an applicant is found to meet the Program’s income eligibility standards as specified in Regulation .07 of this chapter, in order for the applicant to receive WIC benefits, the applicant shall be found by the Program to be at nutritional risk. In order to determine whether an applicant is at nutritional risk, a competent professional authority or a competent paraprofessional authority on the staff of the local agency shall perform a nutritional assessment based on either information gathered by the local agency or information provided by a competent professional authority not on the staff of the local agency. A local agency may not compel an applicant to: Have the nutritional risk assessment completed by a specific medical provider; or Receive ongoing medical care under the local agency. In conducting a nutritional risk assessment, a local agency, competent professional authority, or competent paraprofessional authority shall assess each applicant’s height (or length) and weight measurements at the time of certification by: Performing the measurements on each applicant; Requiring documentation of each applicant's measurements from a health care provider; or In its discretion, both §D(1) and (2) of this regulation. Hematological Tests. In addition to the assessments set forth in §D of this regulation, a local agency, competent professional authority, or competent paraprofessional authority shall: Perform a hematological test for anemia such as a hemoglobin or hematocrit; Require documentation of the test from a health care provider at the time of certification for applicants with no other nutritional risk factor present; or In its discretion, both §E(1)(a) and (b) of this regulation. For applicants with a qualifying nutritional risk factor present at certification, a local agency, competent professional authority, or competent paraprofessional authority shall within 90 days of the certification: Perform a hematological test; Require documentation of the test from a health care provider; or In its discretion, both §E(2)(a) and (b) of this regulation. The local agency, competent professional authority, or competent paraprofessional authority shall perform or require documentation of the hematological test as follows: For a pregnant woman, during pregnancy; For a breastfeeding or postpartum woman, after the termination of pregnancy; For a breastfeeding woman 6—12 months postpartum, if a test was not performed after the termination of pregnancy or whose test result after pregnancy was below normal range; For an infant, 9—12 months old; For a child 12—24 months old, any time during that period, but, if possible, at 6 months after the infant test; For a child 2 years old or older, whose test result at the child's last certification is within the normal range, at least once every 12 months; and For a child 2 years old or older whose test result at the child’s last certification is below normal range, at 6 month intervals until the result is within normal range. The local agency, competent professional authority, or competent paraprofessional authority shall obtain a nutrition history for each applicant. Using the information gathered pursuant to §§D—F of this regulation, a competent professional authority or competent paraprofessional authority shall use the nutritional risk criteria found in Charts A and B in Regulation .11 of this chapter to determine if the applicant is at nutritional risk pursuant to the priority levels set forth in Regulation .09 of this chapter, and thus eligible for the Program. A local agency: May determine a breastfeeding woman to be at nutritional risk if her breastfed infant has been determined to be at nutritional risk; May certify a breastfed infant to be at nutritional risk if the infant's mother is determined to be at nutritional risk; Shall place a breastfeeding mother and her infant in the highest priority level for which either is qualified; Shall place an applicant exhibiting more than one risk factor in the highest applicable priority level; and May not place an individual in successive certification periods whose only identified risk factor is possibility of regression of nutritional status. A local agency shall classify applicants according to priority levels of nutritional risk. Priority Levels of Nutritional Risk. Priority I. Priority I is a pregnant woman, a breastfeeding woman, or an infant at nutritional risk because of: Detrimental or abnormal nutritional conditions detected by biochemical or anthropometric measurements; Other documented nutritionally related medical conditions; or Conditions that directly affect the nutritional health of an individual, including depression, smoking, alcoholism, or drug abuse. Priority II. Except for an infant who qualifies for Priority I, Priority II is: An infant younger than 6 months old born to a woman who was a Program participant during her pregnancy; An infant younger than 6 months old born to a woman who was not a Program participant during pregnancy but whose medical records document that the woman was at nutritional risk during the pregnancy due to nutrition conditions detectable by biochemical or anthropometric measurements or other documented, nutritionally related medical conditions that demonstrated the individual’s need for supplemental foods; or A breastfeeding mother of a breastfed infant who has been certified in the Program as Priority II. Priority III. Priority III is a child or postpartum woman at nutritional risk because of: Detrimental or abnormal nutritional conditions detected by biochemical or anthropometric measurements; Other documented nutritionally related medical conditions; or Conditions that directly affect the nutritional health of an individual, including depression, smoking, alcoholism, or drug abuse. Priority IV. Priority IV is a: Pregnant woman, a breastfeeding woman, or an infant at nutritional risk because of: Dietary deficiencies that impair or endanger health; or Conditions that predispose the individual to inadequate nutritional patterns, including homelessness or migrancy; and Breastfeeding woman or an infant at nutritional risk because of possibility of regression of nutritional status. Priority V. Priority V is a child at nutritional risk because of: Dietary deficiencies that impair or endanger health; Conditions that predispose the child to inadequate nutritional patterns, including homelessness or migrancy; or Possibility of regression of nutritional status. Priority VI. Priority VI is a postpartum woman at nutritional risk because of: Dietary deficiencies that impair or endanger health; Conditions that predispose the individual to inadequate nutritional patterns, including homelessness or migrancy; or Possibility of regression of nutritional status. When it is serving its maximum caseload, a local agency shall maintain a priority waiting list of individuals seeking Program benefits. In order to be placed on the priority waiting list, an individual shall be certified as eligible to participate in the Program. A local agency shall place an individual on a priority waiting list according to the priority levels set forth in Regulation .09 of this chapter, as follows: To be placed on the priority waiting list in Priority levels I—V, an individual shall seek certification and be successfully certified by the local agency as eligible for Program benefits; and To be placed on the priority waiting list in Priority level VI, an individual may request to be on the waiting list over the telephone, unless the individual's postpartum status is at issue, in which case the local agency shall place the individual on the waiting list only after the individual receives a personal assessment at the local agency. The State agency may advise the local agency that one or more priority levels may be excluded from consideration for the waiting list if it is not possible for those priority levels to be placed on the Program in the foreseeable future. However, if an applicant meets the requirements for one of the priority levels and requests placement on a priority waiting list, the applicant may not be denied inclusion. An individual on the waiting list shall be selected for Program participation as soon as services become available. An individual in the highest priority level of the waiting list shall receive services before an individual in the next highest priority level on the waiting list receives services. Within a priority group, an applicant shall receive services on a first-come, first-served basis. A local agency shall notify an individual of placement on the waiting list within 20 days of the date that the individual applies for Program benefits, or in the case of an infant or pregnant woman, within 10 days of the date that the application for benefits was made. For purposes of the WIC Program, to be considered at nutritional risk: A woman shall exhibit one or, where specified, two of the nutritional risk factors listed in Chart A, as shown in §B of this regulation; and An infant or child shall exhibit one or, where specified, two of the nutritional risk factors listed in Chart B, as shown in §B of this regulation. Explanation of Charts. Chart A. Chart B. A local agency shall perform the certification process at no cost to the applicant. To lend administrative efficiency and participant convenience to the certification process, a local agency shall, whenever possible, use intake procedures for processing applications that are combined with intake procedures for other health programs or services administered by the local agency. These procedures may include: Verification procedures; Certification interviews; and Income computations. When a local agency is not serving its maximum case load, the local agency shall: Accept an application; Arrive at an eligibility determination; Notify the applicant of the decision made; and Issue food instruments pursuant to the terms set forth in §E of this regulation. To ensure that accurate records are kept of the date of an application, the local agency shall, at the time of each visit record the: Applicant's name; Applicant's address; and Date of the visit. Time Frames. A local agency shall notify a special nutritional risk applicant of an eligibility or ineligibility determination within 10 days of the date of the application for Program benefits, except that the State agency may provide an extension of the notification period to a maximum of 15 days for the local agency that makes a written request which includes a justification of the need for an extension; or A local agency shall notify other applicants of their eligibility or ineligibility within 20 days of the date of the application for Program benefits. If, during a certification visit, a local agency determines that an applicant is ineligible for the Program, the local agency shall: Inform the special nutritional risk applicant within 10 days of the certification visit, and other applicants within 20 days of the certification visit, of the: Applicant's ineligibility; Reason for ineligibility; and Applicant's right to a fair hearing on the ineligibility determination; Document the reasons for ineligibility; and Retain this information on file at the local agency. At the same time an applicant completes the certification process and the local agency determines the applicant to be eligible for Program benefits, the local agency shall issue benefits for up to 90 days. A local agency shall certify an applicant for Program benefits for the following time periods: A pregnant woman for the duration of her pregnancy and up to the last day of the month in which the infant turns 6 weeks old or the pregnancy ends; A postpartum woman up to the last day of the 6th month after the infant is born or the pregnancy ends; A breastfeeding woman up to the last day of the month of the breastfed infant’s first birthday as long as the woman is breastfeeding; An infant younger than 6 months old up to the last day of the month of the infant’s first birthday; An infant from 6 months old to 1 year old up to the last day of the 6th month from the date of certification; and A child 1 year old or older up to the last day of the month 1 year from the date of the certification or the month in which the child turns 5 years old. When there is difficulty in appointment scheduling for participants referred to in §A(4)—(6) of this regulation, a local agency may shorten or extend the certification period by not more than 30 days on a case-by-case basis. A local agency may use anthropometric data for a nutrition risk determination that precedes the date of certification by up to 60 days and bloodwork data following U.S. Centers for Disease Control and Prevention recommendations with no reduction in the length of certification. Anthropometric data for an individual certified as a pregnant woman shall be collected during the pregnancy, and data for an individual certified as a postpartum or a breastfeeding woman shall be collected after the termination of the pregnancy. Not less than 15 days before the expiration of a certification period, the Program shall notify a participant, or a child or infant participant's parent, guardian, or caretaker that the participant's certification period for the Program is about to expire. A participant, or a child or infant participant's parent, guardian, or caretaker shall apply in person for benefits for the next certification period. A local agency may disqualify a participant in the middle of a certification period for Program abuse, which includes but is not limited to: The sale or exchange of food instruments or food obtained with a food instrument; Dual participation; Making false or misleading statements or intentionally misrepresenting, concealing, or withholding information in order to obtain benefits; Verbal or physical abuse of or threat of physical abuse to Program or vendor staff; Receipt from food vendors of cash or credit toward the purchase of unauthorized food or other items of value instead of authorized supplemental foods; and Failure to pick up food benefits for 2 consecutive issue months. Funding Shortages. If the State agency experiences funding shortages, it may discontinue Program benefits to participants, but only after exploring alternative actions. The State agency may discontinue benefits by: Disqualifying a priority level of participants; or Withholding benefits to a priority level with the expectation of providing benefits again when funds are available. When the State agency elects to restrict benefits to a priority level of participants due to insufficient funds for a period of time: The State agency shall discontinue benefits for: The least possible number of participants; Those participants whose nutritional and health status would be least impaired by the discontinuation of Program benefits; and A local agency may not enroll new participants in restricted priority levels during this period. Ineligibility. A local agency shall disqualify a participant in the middle of a certification period if, on the basis of a reassessment of Program eligibility status, the individual is determined ineligible for Program benefits. A participant may not engage in dual participation. The State agency in conjunction with the local agency is responsible for the detection and prevention within its program of dual participation. The local agency shall take immediate actions to investigate and resolve all incidents of suspected Program abuse involving dual participation. In order to prevent possible dual participation by an applicant, at certification the local agency shall verify the identity of each applicant and shall use the following to establish the identity of the infant or child applicant: Immunization record; Birth certificate; or Other record that the local agency considers adequate to establish the identity of an infant or child applicant. At the time of certification, a local agency shall inform an applicant or the parent, guardian, or caretaker of a child or infant applicant, of the following: The applicant may not engage in dual participation; The Program violations and the sanctions applicable to a participant, a child or infant participant's parent, guardian, or caretaker, or proxy for committing those violations; The importance of regularly picking up food benefits and food; The disqualification policy for failure to pick up food benefits and the number of months of nonparticipation resulting from the disqualification; The policy of not providing notification of disqualification to the participant when the participant fails to pick up food benefits; The right to a fair hearing if the participant does not agree with the disqualification for failure to pick up food benefits; How the local agency food delivery system operates and a list of authorized stores where food benefits may be redeemed; The available health services, where they are located, how they may be obtained, and why they may be useful; A participant or a child or infant participant’s parent, guardian, or caretaker shall notify the local agency of any change in life circumstances that would have an impact on Program eligibility; and A participant or a child or infant participant’s parent, guardian, or caretaker shall advise any designated proxy of the proxy’s obligations under the Program, Program violations, participant and proxy sanctions, and the authorized food stores. At the time of certification, the Program applicant or a child or infant applicant’s parent, guardian, or caretaker shall read, or the Program representative or a local agency staff person shall read to the individual, the following: “The rules for applying for WIC are the same for everyone;” “I can ask a WIC employee for a fair hearing if someone tells me I cannot be on WIC and I do not agree;” and “I will get information about healthy eating and active living. WIC will help and support me with breastfeeding. I will get information about immunizations and other services I might need.” After advising the applicant, or the child or infant applicant’s parent, guardian, or caretaker of the rights and responsibilities set forth in this regulation, the applicant or the child or infant applicant’s parent, guardian, or caretaker, shall read, or a Program representative shall read to the applicant, or the child or infant applicant’s parent, guardian, or caretaker, the following statements: “I understand what my rights and responsibilities are;” “I agree to follow the rules below. I will:(i) not sell, give away or trade my eWIC card, foods, or formula for money, credit, rain checks or other items. If I have WIC items I can’t use, I will return them to the clinic; (ii) not post WIC items for sale or trade on the internet; (iii) not swear, yell, harass, threaten, physically harm WIC or store staff, or damage WIC or store property; (iv) not enroll a child who is not in my legal or designated care; and (v) not enroll in WIC in more than one state or get benefits from more than one WIC clinic each month;” “The information I have provided for eligibility determination is correct, to the best of my knowledge;” “The information that I provide to the WIC Program is being submitted in connection with the receipt of federal assistance;” “Program officials may verify information provided to them;” “I understand and agree that intentionally making a false or misleading statement or misrepresenting, hiding, or withholding facts may result in my having to pay the WIC Program, in cash, the value of the food benefits improperly issued to me and may subject me to civil or criminal prosecution under State and federal law and disqualification from the WIC Program;” and “I agree to give true and complete information about changes in my life circumstances that would have an impact on my eligibility for WIC benefits (for example, I will notify WIC if I have changes in my income or family size or if I move).” The applicant or the child or infant applicant’s parent, guardian, or caretaker, shall acknowledge the reading of the statements enumerated in §C of this regulation by signing the Rights and Responsibilities form provided by the State agency. A local agency shall: Issue a verification of certification to a participant who: Is a member of a family in which there is a migrant farm worker; or Advises the local agency that the participant's family is likely to be relocating outside of Maryland during the certification period; Ensure that each verification of certification contains the following: Name of the participant; Date the certification was performed; Date the income eligibility was last determined; Nutritional risk condition of the participant; Date the certification expires; Signature and printed or typed name of the local agency official who issued the verification of certification; The name and address of the certifying local agency; and An identification number for the verification of certification or some other means of accountability; Accept a valid verification of certification from a participant of a WIC Program whether within or outside of Maryland; and Accept the verification of certification or the copy of the State-approved certification form as proof of eligibility for WIC Program benefits until the participant’s certification period expires. A local agency may not: Issue a verification of certification to an individual placed on the waiting list; or Deny participation in the Maryland WIC Program to an individual with a valid verification of certification because of a difference between another state’s and Maryland’s eligibility criteria. A local agency may use the verification of certification as verification of income eligibility for the family of a migrant farm worker if the migrant farm worker is currently away from the migrant farm worker’s home jurisdiction, and if the migrant farm worker’s family income has been determined within the last 12 months. A local agency having a waiting list for participation that receives a transferring participant shall place the transferring participant ahead of waiting applicants without regard to priority level. Nutrition Benefits. A local agency shall: Ensure that nutrition education is offered every 3 months to the participant or the parent, proxy, guardian, or caretaker of an infant or child participant during each certification period; Provide a nutrition care plan to the participant, based on the need for this plan as determined by a competent professional authority, and to a participant, parent, proxy, guardian, or caretaker who requests a nutrition care plan; Ensure that a competent professional authority or competent paraprofessional authority determines the selection of the food package according to the category and nutritional need of the participant; and Ensure that the food package is consistent with foods allowed under the provisions of 7 CFR §246.10, which is incorporated by reference in Regulation .03 of this chapter. Proxies. If a participant or a child or infant participant’s parent, guardian, or caretaker is unable to pick up or redeem WIC benefits, the participant or the child or infant participant’s parent, guardian, or caretaker may name a proxy to pick up benefits, redeem them, or both. A participant or a child or infant participant's parent, guardian, or caretaker shall register the name of the proxy with the local agency before the proxy may perform any WIC-related activity. The Program may remove an individual who violates Program standards from serving as a proxy. A participant or a child or infant participant's parent, guardian, or caretaker may replace a proxy with another individual. A participant or a child or infant participant's parent, guardian, or caretaker shall advise a proxy of the: Proxy's obligations under the Program; Program violations; Participant and proxy sanctions; and Authorized food stores. Receipt of Food Benefits. Except as provided in §B(3) and (4) of this regulation, a participant or the participant’s proxy shall report to a designated site at designated times to receive food benefits prepared for that participant and to acknowledge receipt of the benefits. When distributing food benefits, a local agency shall check a participant’s identification. A local agency may mail or otherwise deliver food benefits to participants on a local agency-wide basis if the State agency approves this action on the basis of a hardship that may be encountered by the target population, such as seasonally inclement weather. A local agency may mail or otherwise deliver food benefits to the participant or the participant’s parent, guardian, or caretaker who in writing requests this delivery and explains why it is necessary if a participant and the participant’s proxy are unable to report to the designated site to receive food benefits due to a hardship, including, but not limited to: Illness; Handicap; Imminent childbirth; or Difficulty of access to the site. If the hardship cited in §C(4) of this regulation does not allow time for a written request to be made, a local agency may act on a verbal request for the upcoming benefit distribution period only and shall follow the procedure set forth in §C(4) of this regulation if the hardship continues. When the hardship is resolved, a local agency shall continue with normal benefit issuance procedure. Receipt and Consumption of Food. To obtain WIC-authorized foods, a participant or proxy shall complete transactions at WIC-authorized vendors. Only the participant for whom the food package was prescribed shall consume food obtained with a WIC food instrument. The Program may sanction a participant or proxy in the Program, in addition to seeking criminal or civil sanctions or other remedies that may be applicable under federal, State, or local law. If a participant or a child or infant participant’s parent, guardian, or caretaker, has deliberately misrepresented the participant’s income, residence, family size, health status, medical data, or date of birth, the: Program shall disqualify the participant from the program for 1 year; and Offending party shall pay to the State agency, in cash, the value of food benefits improperly received. If a participant or a child or infant participant’s parent, guardian, caretaker, or proxy obtains or attempts to obtain food benefits to which the participant is not entitled, sanctions shall be applied according to the following: If the offending party is a participant or a child or infant participant's parent, guardian, or caretaker: For the first offense, the Program shall counsel the individual and issue a warning letter; For a subsequent offense, the Program shall disqualify the participant from the Program for: 3 months; or 1 year if the State agency assesses a monetary claim of $100 or more; and In either case in §C(1)(a) and (b) of this regulation, the offending party shall pay to the State agency, in cash, the value of the food benefits obtained; or If the offending party is a proxy, the: Program shall remove the proxy; and Proxy shall pay to the State agency, in cash, the value of the food benefits obtained. If a participant engages in dual participation as defined in Regulation .04B of this chapter: The Program shall counsel the participant or a child or infant participant’s parent, guardian, or caretaker, and disqualify the participant for 1 year; and The offending party shall pay to the State agency, in cash, the monetary value of the items received. If a participant or a child or infant participant’s parent, guardian or caretaker, or a proxy physically abuses or threatens abuse of WIC or vendor staff, the Program shall: Report the incident to the police; Disqualify the participant from the Program for 1 year if the offending party is a participant or a child or infant participant’s parent, guardian, or caretaker; and Remove the proxy if the offending party is a proxy. If a participant or a child or infant participant’s parent, guardian, or caretaker, or a proxy verbally abuses or harasses WIC or vendor staff, or disrupts the peaceful and orderly conduct of business at a WIC or vendor facility, the Program shall: For the first offense, disqualify the participant from the Program for 6 months; Remove the proxy if the offending party is a proxy; and For a subsequent offense, disqualify the participant from the Program for 1 year. If a participant or a child or infant participant’s parent, guardian, or caretaker, or a proxy sells or exchanges supplemental food purchased with a food instrument or sells a food instrument to another individual or entity, the: Program shall: Disqualify the participant for 3 months if the offending party is a participant or a child or infant participant's parent, guardian, or caretaker; or For a subsequent offense, disqualify the participant from the Program for 6 months if the offending party is a participant or a child or infant participant’s parent, guardian, or caretaker; Disqualify the offending party for 1 year if the State agency assesses a monetary claim of $100 or more; or Remove the proxy if the offending party is a proxy; and Offending party shall pay to the State agency, in cash, the monetary value of food or food instruments sold or exchanged. If a participant or a child or infant participant’s parent, guardian, or caretaker, or a proxy attempts to redeem or redeems a food instrument for unauthorized foods or for quantities of food in excess of that indicated on the food instrument, if the offending party is a: Participant or a child or infant participant’s parent, guardian, or caretaker: For the first offense, the Program shall counsel the individual and issue a warning letter; For a subsequent offense, the Program shall disqualify: The participant from the Program for 3 months; or The offending party from the Program for 1 year if the State agency assesses a monetary claim of $100 or more; and In either case in §H(1)(a) and (b) of this regulation, the offending party shall pay to the State agency, in cash, the value of the food benefits obtained; or Proxy, the: Program shall remove the proxy; and Proxy shall pay to the State agency, in cash, the value of the food benefits obtained. If a participant or a child or infant participant’s parent, guardian, or caretaker, or a proxy receives cash or credit toward the purchase of unauthorized food or other items of value instead of or in addition to authorized supplemental foods or exchanges, or attempts to exchange or returns or attempts to return authorized WIC food to the vendor for cash or non-WIC items, the: Program shall: Disqualify the participant from the Program for 3 months if the offending party is a participant or a child or infant participant’s parent, guardian, or caretaker; For a subsequent offense, disqualify the participant from the Program for 6 months if the offending party is a participant or a child or infant participant’s parent, guardian, or caretaker; or Disqualify the offending party for 1 year if the State agency assesses a monetary claim of $100 or more; Program shall remove the proxy if the offending party is a proxy; and Offending party shall pay to the State agency, in cash, the amount indicated on the food instrument with which the items were initially obtained, if the items were obtained. If a participant or a child or infant participant’s parent, guardian, or caretaker, or a proxy allows an unauthorized individual to use the Maryland WIC participant identification folder, if the offending party is a: Participant or a child or infant participant’s parent, guardian, or caretaker: For the first offense, the Program shall counsel the individual and issue a warning letter; and For a subsequent offense, the Program shall disqualify the participant from the Program for 3 months; or Proxy, the Program shall remove the proxy. If a participant or a child or infant participant’s parent, guardian, or caretaker, or a proxy fails to pay a monetary penalty imposed by the Program for redeeming food benefits, if the offending party is a: Participant or a child or infant participant’s parent, guardian, or caretaker, the Program shall disqualify the participant from the Program for 1 year; or Proxy, the Program shall remove the proxy. Failure to Return Breast Pump. If a participant fails to return a hospital grade breast pump, the Program shall issue a warning letter to the participant. If a participant fails to return a hospital grade breast pump after receipt of a warning letter, the participant shall pay to the State agency, in cash, the monetary value of the breast pump. A local agency shall implement participant and proxy sanctions and notify the State agency of the action taken. The State agency may also initiate participant and proxy sanctions and other acts based on information available to the State agency. Except for a participant the State agency disqualifies for failure to pick up food benefits, the State agency shall, not less than 15 days before disqualification, advise the participant in writing of the reasons for the disqualification and of the right to a fair hearing on the disqualification. When the State agency pursues collection of a claim against a participant who has been improperly issued food benefits, it shall advise the participant in writing of: The reasons for the claim; The value of the improperly issued benefits to be repaid to the Program; That the participant shall pay to the State agency, in cash, the value of the improperly issued benefits; and The participant's right to a fair hearing on the claim. Applicants and participants may appeal certain State or local agency actions. An applicant or participant: May appeal a State or local agency action resulting in the individual's being: Denied participation in the WIC Program; Instructed to repay the cash value of improperly issued benefits; or Disqualified from the Program; and Shall appeal the action in accordance with COMAR 10.01.06. Civil Rights Requirements. To ensure that an individual may not, on the grounds of race, color, national origin, age, sex, or handicap, be excluded from participation in, be denied benefits of, or be otherwise subjected to discrimination under the Program, a local agency shall comply with the requirements of: Title VI of the Civil Rights Act of 1964 as incorporated by reference in Regulation .03C of this chapter; Title IX of the Education Amendments of 1972 as incorporated by reference in Regulation .03C of this chapter; §504 of the Rehabilitation Act of 1973 as incorporated by reference in Regulation .03C of this chapter; The Age Discrimination Act of 1975 as incorporated by reference in Regulation .03C of this chapter; USDA Food and Nutrition Service instructions issued by the Program to the local agencies; and USDA regulations on nondiscrimination as incorporated by reference in Regulation .03C of this chapter. A local agency shall: Notify the public of the nondiscrimination policy and complaint rights of a participant and an applicant as set forth in §B of this regulation; Review and monitor its activities to ensure Program compliance with the nondiscrimination laws and regulations; and Collect and report racial and ethnic participation data as required by Title VI of the Civil Rights Act of 1964, which prohibits discrimination in federally assisted programs on the basis of race, color, or national origin. Complaints. An individual may submit to a local agency a complaint that alleges an incident of discrimination pursuant to §A of this regulation. The local agency shall forward to the State agency, within 10 days, the complaint which alleges discrimination. The State agency shall refer the complaint, including a complaint based on sex or handicap, to the USDA for investigation and necessary action. The Program shall accommodate the non-English-speaking individuals in the population eligible to be served as set forth in this chapter. When the population eligible to be served needs services or information in a language other than English in order to be informed of or to participate in the Program, the local agency shall: Take reasonable steps to provide Program information in the appropriate language; and Ensure that the rights and responsibilities listed on the certification form are read to the applicant in the appropriate language. If the provisions of this chapter conflict with federal statutes and regulations, including the provisions incorporated by reference in Regulation .03 of this chapter, the federal statutes and regulations prevail. Health-General Article, §18-107(a), Annotated Code of Maryland Effective date: Regulations .01—.12 adopted as an emergency provision effective February 21, 1986 (13:6 Md. R. 670); emergency status expired May 31, 1986 Regulations .01—.12 adopted as an emergency provision effective June 4, 1986 (13:13 Md. R. 1477); adopted permanently effective October 20, 1986 (13:21 Md. R. 2321) Regulation .03 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214) Regulation .03B amended effective March 19, 1990 (17:5 Md. R. 638) Regulation .04 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214) Regulation .04B amended effective March 19, 1990 (17:5 Md. R. 638) Regulation .06C, E amended effective March 19, 1990 (17:5 Md. R. 638) Regulation .07 amended effective March 19, 1990 (17:5 Md. R. 638) Regulation .09D amended effective March 19, 1990 (17:5 Md. R. 638) Regulation .10 amended effective March 19, 1990 (17:5 Md. R. 638) Regulations .01—.12 repealed and Regulations .01—.24 adopted effective March 25, 1996 (23:6 Md. R. 476) Regulation .02A amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .03 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214); amended permanently effective May 13, 2002 (29:9 Md. R. 745) Regulation .03 amended effective April 16, 2012 (39:7 Md. R. 494) Regulation .04 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214); amended permanently effective May 13, 2002 (29:9 Md. R. 745) Regulation .04B amended effective April 16, 2012 (39:7 Md. R. 494); May 18, 2020 (47:10 Md. R. 519) Regulation .05B amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .06B, C amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .07 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214); amended permanently effective May 13, 2002 (29:9 Md. R. 745) Regulation .07 amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .07D amended effective November 29, 1999 (26:24 Md. R. 1858) Regulation .07E amended effective April 16, 2012 (39:7 Md. R. 494) Regulation .08 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214); amended permanently effective May 13, 2002 (29:9 Md. R. 745) Regulation .08 amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .09 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214); amended permanently effective May 13, 2002 (29:9 Md. R. 745) Regulation .09B amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .10 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214); amended permanently effective May 13, 2002 (29:9 Md. R. 745) Regulation .10A, B amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .11 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214); amended permanently effective May 13, 2002 (29:9 Md. R. 745) Regulation .11 amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .12A, G amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .13 amended as an emergency provision effective January 15, 2002 (29:3 Md. R. 214); amended permanently effective May 13, 2002 (29:9 Md. R. 745) Regulation .13 amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .14A, B, C amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .15A amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .16 amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .17 amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .18 amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .19 amended effective March 31, 2014 (41:6 Md. R. 380); May 18, 2020 (47:10 Md. R. 519) Regulation .20C, D amended effective May 18, 2020 (47:10 Md. R. 519) Regulation .22 amended effective May 18, 2020 (47:10 Md. R. 519)