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WIC Use Only

Notification Of Ineligibility Or Terminator Form

SKU: WIC-5V-PDF
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Description

(REV 12/08) Restricted for WIC Use Only Use this form when an applicant is determined ineligible for WIC or a participant is terminated. The form includes the opportunity to register to vote (NVRA WIC) for ineligible applicants. The form can be used for more than one family member.