Fill Out Your Wisconsin F 40052A Template
Outline
The Wisconsin F 40052A form is an essential document for the Wisconsin WIC Program, aimed at facilitating the ordering of breast pumps and related accessories for eligible clients. This form allows health professionals to request various types of breast pumps, including multi-user rental electric pumps and personal electric models, as well as necessary accessories like breastshields and battery packs. Each item has specific ordering guidelines, such as quantity per case or unit, ensuring that clients receive the appropriate equipment for their needs. The form also requires basic information, including the project number and due date, which helps streamline the ordering process. While completion of the form is voluntary, the information gathered plays a crucial role in ensuring that mothers have access to the resources they need for successful breastfeeding. Once filled out, the form can be mailed or faxed to the Wisconsin WIC Program's Nutrition Section, making it easy to submit requests efficiently. Understanding the details of the F 40052A form can greatly benefit both healthcare providers and clients navigating the WIC program.
Steps to Filling Out Wisconsin F 40052A
To complete the Wisconsin F 40052A form, follow the outlined steps carefully. This form is used to order breast pumps for clients. Ensure all information is accurate before submitting the form via mail or fax.
- Obtain the Wisconsin F 40052A form from the Wisconsin Department of Health Services website or your local WIC office.
- Locate the section labeled "Order Period and Due Date." Check the appropriate box for the quarter in which you are ordering: 1st, 2nd, 3rd, or 4th quarter.
- Fill in the "Project Number" field with the relevant project number.
- Enter the "Project Name" in the designated area.
- In the "Manufacturer/Product" section, list the product name and the quantity you wish to order. Make sure to select the correct unit of measurement (e.g., each, per case).
- If ordering optional accessories, include them in the same manner as the main products, specifying the quantity and unit of measurement.
- Provide your shipping information only if it has changed since your last order. Fill in your street address, city, and zip code.
- Identify the primary contact person by entering their name, area code, and telephone number.
- Optionally, include an email address for any follow-up communication.
- Review the completed form for accuracy and completeness.
- Mail the form to the Wisconsin WIC Program, Nutrition Section, PO Box 2659, Madison, WI 53701-2659, or fax it to 608-266-3125.
Key takeaways
Here are some key takeaways about filling out and using the Wisconsin F 40052A form:
- Voluntary Completion: Filling out the form is not mandatory, but it is necessary to order and ship breast pump materials.
- Order Period: Be mindful of the order period and due dates. They are set for December 7, March 7, June 7, and September 7.
- Project Number: Make sure to include the correct project number to ensure proper processing of your order.
- Manufacturer and Product Selection: Carefully select the manufacturer and product you wish to order. Each product has specific ordering units, such as per case or each.
- Shipping Information: Only provide shipping information if it has changed since your last order to avoid confusion.
- Contact Information: Include a primary contact person along with their phone number and email to facilitate communication if needed.
- Submission Options: You can either mail the completed form to the specified address or fax it to the provided number for quicker processing.
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Documents used along the form
The Wisconsin F 40052A form is utilized for ordering breast pumps through the WIC program. It serves as a crucial document for ensuring that clients receive the necessary equipment to support breastfeeding. Along with this form, several other documents may be required to facilitate the process of obtaining breast pumps and related accessories. Below are descriptions of these commonly used forms.
- WIC Application Form: This form is necessary for individuals applying to the WIC program. It collects information about the applicant's household, income, and nutritional needs to determine eligibility for benefits.
- Quitclaim Deed Form: This document facilitates the transfer of real estate interests without title guarantees, often useful for family member transactions. For a comprehensive guide, refer to the PDF Document Service.
- WIC Certification Form: This document is used to certify participants in the WIC program. It includes details about the applicant's health, nutritional status, and the services they will receive during their enrollment.
- Breastfeeding Support Referral Form: This form is used to refer clients to breastfeeding support services. It ensures that individuals receive the guidance and assistance needed for successful breastfeeding.
- Client Information Update Form: This document allows WIC participants to update their personal information, such as address or contact details, ensuring that their records remain current and accurate.
These forms work in conjunction with the Wisconsin F 40052A to streamline the ordering process for breast pumps and ensure that clients receive the appropriate support and resources during their breastfeeding journey.