Items:

1. Did {name} receive benefits from WIC, that is, the Women, Infants, and Children program, in the past 12 months?
2. Is {name} now receiving benefits from the WIC program?
3. Did {name} receive benefits from WIC when {heshe} was less than one year old?
4. Did {name} receive benefits from WIC when {heshe} {wasis} between the ages of {1 to {current age4} years old12 to {current age} months old}?

Response Options:
Yes
No
Refused
Don't know

5. How long {did name receivehas name been receiving} benefits from the WIC program?

Response Options:
[__] numeric
Refused
Don't know

Enter unit:
Month - 1
Years - 2
Refused - 7
Don't know - 9

6. Did {name’s} mother receive benefits from WIC, while she was pregnant with {name}?

Response Options:
Yes
No
Refused
Don't know

7. What month of the pregnancy did {name’s} mother begin to receive WIC benefits?

Response Options:
[__] month
Refused
Don't know