What is the WIC Assistance Documentation Form for?

It supplements the WIC income eligibility application by documenting assistance received or confirming that the applicant's household receives no income or outside support.

Who completes this form?

A person providing assistance completes Section I. Section II may be completed by an eligible non-relative, such as church, school, or public-service personnel, who does not live in the applicant's household or work for WIC.

Do I need a notary for the WIC Assistance Documentation Form?

No. This form is signed and dated without a notary, and it lists no notarized or sworn attachment.

Hidalgo County, TX · Hidalgo County

No notary required

WIC Assistance Documentation Form

This WIC form documents whether an applicant receives financial or in-kind assistance, or has no household income, as part of an income eligibility application.

At a glance

Issued by: City of Hidalgo County · Hidalgo County, Hidalgo County, Texas
Notarization: Not required: file this form without a notary.
Official source: hidalgocounty.us
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

The form is a supplement to the WIC income eligibility application and must be completed if the applicant reports that no one in the household has income. It has sections for a person providing assistance or an eligible non-relative who can confirm the applicant receives no income or outside support. Signers provide their names, signatures, dates, and other requested contact or agency details.

Who needs it

WIC applicants reporting no household income may need this form, completed by a person providing assistance or an eligible person confirming no assistance is received.

How to submit it

Submit it to the county office named on the form; check the county website for current contact details.

About notarization

This form is signed and dated without a notary; it lists no notarized or sworn attachment, so each applicable signer simply signs and dates it.

How to submit this form

1
Download the Form
Download the WIC Assistance Documentation Form.
2
Complete the Applicable Section
Complete Section I if someone provides assistance, or Section II if an eligible person confirms the applicant receives no income or outside support.
3
Gather Supporting Details
Provide the requested names, signature, date, and applicable contact, title, agency, or employer information.
4
Submit to the County
Submit it to the county office named on the form; check the county website for current contact details.

Frequently asked questions

What is the WIC Assistance Documentation Form for?: It supplements the WIC income eligibility application by documenting assistance received or confirming that the applicant's household receives no income or outside support.
Who completes this form?: A person providing assistance completes Section I. Section II may be completed by an eligible non-relative, such as church, school, or public-service personnel, who does not live in the applicant's household or work for WIC.
Do I need a notary for the WIC Assistance Documentation Form?: No. This form is signed and dated without a notary, and it lists no notarized or sworn attachment.
How do I submit the WIC Assistance Documentation Form?: Submit it to the county office named on the form; check the county website for current contact details.

Need something notarized?

This WIC Assistance Documentation Form doesn’t need a notary, but Texas residents can notarize other documents online with a commissioned online notary.