WIC Participant Complaint Form

if available
WIC Participant’s Gender

Please list names and WIC participant ID Numbers (if available)
if available
Please enter the phone number in XXX-XXX-XXXX format.

In the box below, please provide a description of the complaint against the WIC participant or caregiver. Be sure to include the important details such as names of persons involved and dates if available.

Have you ever filed a complaint against this WIC Participant/Caregiver?

Time Format Example: 2:00 pm

You are able to file a WIC Participant/Caregiver complaint anonymously, but if you would like the WIC State Agency to contact you, please complete the fields below:

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

Powered by Cicero Government