RR: 1 Clinic Records and Reporting Requirements

Effective Date: 06/94 Downloads: PDF Version    Revised Date: 03/17


Nevada State WIC: Records, Reports, and Logs



The following is a summary of all current records and reports required by the WIC program. All reports must be submitted according to the deadline listed. If agencies are unable to meet these deadlines, they may request an extension in writing. Extensions are subject to approval by the State Office.

It is very important that reports are submitted appropriately and timely. Reports submitted past the due date, without notification, will result in delayed reimbursements and may result in a reduction of future funds.

LA should retain a copy of all information sent to the State for their records. Refer to the associated policy/procedure for more detail.

Submit to the State Office
Administrative Cost Report


Report must be submitted on authorized State Form. Monthly RR: 2
Local Agency Nutrition Services Plan Report must be submitted State format Yearly – Aug. GP: 6
Separation of Duties Review   (1 or 2 person clinics only) Completed per policy Quarterly GP:2
Independent Financial Audit Submit copy of audit to State Office. Yearly/As Completed RFP/Budget
Return of Food Instruments Completed per policy (keep copy on file at clinic) Monthly FD:14
Dual Participation Reports must be filled out according to procedure.


Must be returned to the State Office by the due date indicated on the report.

Monthly RR: 3
Receipt of WIC F.I’s Must be completed by the employee receiving the F.I.’s Within 1 week of Receipt RR: 6
Supply Order Must be submitted using the current form. Every 2 Months (Clinics ending with even numbers order on even numbered months; Clinics ending with odd numbers order on odd numbered months) RR: 5
Time and Effort Report Due to the State Office no later than the first Monday of the following month. Monthly RR: 7
Original to State Office/Copy Retained in the Clinic
Complaints LA must have a system for handling clinic and vendor complaints. As Needed CR: 8
Discrimination Log Report must be submitted per procedure.

Copy must also be sent to USDA.

As Needed CR: 5
Voter Registration Mini Tracking Forms Completed per policy Weekly CR:11

Records Retained in Clinic




Conflict of Interest Completed per policy At the time of hire, any updates and annually GP: 12
Confidentiality Statement Completed per policy At time of hire CR:1
Scale Calibration Log Completed per policy Semi-annually RR:10
Agency Referral List/File Completed per policy Review yearly for needed updates OR:2
Application List Completed per procedure. May be done via Chronolist, paper or electronic. Daily CT:2
Breast pump Issuance Logs Completed per procedure. As Needed BF: 1,5
Breastfeeding Peer Counseling Confidentiality Statement (for Peer Counselors only) Completed per policy At time of PC hire BF:7

EBT Card Issuance/Inventory Log & Bulk EBT Card Stock Inventory Log


Completed per policy.

Completed at time of EBT issuance, monthly inventory, and copy of logs due quarterly FD: 2,5,6
Hemocue Log Maintained per licensed laboratory procedures, in accordance with BLC. Daily CT: 12
Staff Training Log Completed per procedure. As trainings are received Clinic Plan, GP:9
Local Agency Self Evaluation Completed per procedure. Once every Fiscal Year PE: 2
Outreach Log Completed per procedure. Quarterly OR: 1
Homeless Facility, Shelter or Institution Agreement Completed per procedure Annual OR: 1
Waiting Lists LA must request permission to establish a waiting list. As Needed GP:4



  • Administrative Cost Report

This report must be completed to request reimbursement for expenditures. Request for Reimbursement Report must be submitted on the approved State form, no later than the 15th of the following month. Reimbursements may be delayed for reports submitted incorrectly or past the deadline.


  • Dual Participation Reports

This report is used to detect fraud and abuse within in the WIC program. Reports must be sent to the State Office by the due date listed.


  • Formula Packing Receipts

Upon receipt of order formula, staff must remove the packing slip; date and initial, and fax a copy to Accounting Assistant III at (775) 684-4211 – Re: Budget# 3214

  • Receipt of Food Instruments

Upon receipt of any food instruments staff must complete each receipt and submit to the State Office.


  • Time and Effort

Local agency staff, whether full-time or partially funded as a part of NSA costs must keep Time Study Daily Logs for each work day the third week of every month. Time and Effort summary’s are due to the State Office by the due date indicated.