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DEPARTMENT OF HEALTH SERVICES Division of Public Health F40076 (08/2018)STATE OF WISCONSINWOMEN, INFANTS, AND CHILDREN (WIC) NUTRITION PROGRAM EMPLOYER STATEMENT Employee Completion of this form is.

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How to fill out the WI F-40076 online

The WI F-40076 is an important form utilized by the Women, Infants, and Children (WIC) Nutrition Program in Wisconsin. This guide will provide you with a comprehensive overview of how to complete this document online, ensuring a smooth process for submitting proof of income.

Follow the steps to effectively complete the WI F-40076 form.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering the employee's full name in the designated space at the top of the form. Ensure the name is spelled correctly as it will be used for identification purposes.
  3. Provide the gross income, which should reflect the most current income information available for the employee. Be as accurate as possible for WIC Program verification.
  4. In the section for the date, input the date when the income information was provided. This helps in maintaining an accurate record.
  5. Fill in the employee's hourly wage. This is crucial for calculating their income accurately.
  6. Enter the business name of the employer. This identifies the company that the employee is affiliated with.
  7. Specify the number of hours the employee works per week. This information contributes to understanding the employee's income potential.
  8. Calculate and document the weekly income derived from the hourly wage and hours worked. This will be reviewed by the WIC program.
  9. Include a telephone number with area code for the employer. This allows for easy contact if further verification is needed.
  10. Provide the employer's address, ensuring it is complete and accurate for documentation purposes.
  11. The employer must print their name, sign, and date the form at the bottom. This signature confirms the information provided is correct.
  12. Once all fields are completed and reviewed for accuracy, save changes, download, or print the form. Ensure the form is returned to the employee after signing.

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