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ATTACHMENT A <br />STATEMENT OF WORK <br />J. Complete part one, part two, or both of the following: <br />a. Part One: Coordinate with DSHS to visit the physical address of a proposed <br />grocery store outlet and determine if a store exists. Grantee shall send DSHS an <br />email correspondence indicating findings. <br />b. Part Two: Coordinate with DSHS to schedule and conduct an on -site evaluation <br />(refer to WIC policy WV 10.0) of the WIC authorized vendor upon request by <br />DSHS and complete the On -site Evaluation within 30 days and submit the form <br />electronically to DSHS within one business day. <br />K. Determine participants' access to health care, medical care and other human services, and <br />make appropriate referrals. Grantee shall have a system in place to provide participants <br />with appropriate health services or make appropriate referrals to health care providers <br />under written agreements that ensure confidentiality of participants' personal <br />information. <br />L. Issue pre - numbered WIC Electronic Benefit Transfer (EBT) cards furnished by DSHS to <br />qualified participants who shall use such EBT cards to obtain specified food items from <br />participating vendors; maintain complete accountability and security of all WIC EBT <br />cards received from DSHS. Grantee shall be held financially responsible for all <br />unaccounted WIC EBT cards and/or for the redeemed value of those issued to ineligible <br />participants. In addition, Grantee shall be held financially liable for issuance of infant <br />formula instruments that are not authorized or prescribed according to the WIC Policy <br />and Procedures Manual. <br />M. Permit DSHS or its agent to install telecommunications equipment at all Grantee WIC <br />clinics and administrative offices using Texas -WIN software on a network or stand alone <br />personal computer. Grantee is required to permit installation at all its permanent WIC <br />sites. Grantee will notify DSHS not less than forty -five (45) days prior to the relocation <br />of a site or the deployment of a new site to allow DSHS or its agent to install <br />telecommunications equipment. <br />N. Connect portable computers (e.g. notebook or laptop) that use Texas -WIN software daily <br />to a DSHS - provided telecommunications access point to transfer data to and receive <br />updates from DSHS. Data transfer and update connection must be made on each day that <br />Grantee provides WIC. <br />O. Review the immunization records of WIC Program applicants /participants to ensure that <br />immunizations are current. Make appropriate referrals to health care providers for <br />necessary immunizations. <br />P. Offer services during extended hours of operation outside the traditional times of 8:00 <br />a.m. to 5:00 p.m., Monday through Friday, according to the Grantee's Annual Plan of <br />Operations as approved by DSHS and incorporated by reference in this Statement of <br />Work. <br />DSHS Contract No. 2016 - 048775 -001 <br />Attachment A - Page 2 <br />