Prenatal – Early Childhood Nutrition Supplement Information for Applicants

To apply, please complete the attached Application for the Prenatal – Early Childhood Nutrition Supplement (PECNS) and Applicant Consent and Release of Information and return with the following documents: o Verification of Social Insurance Number (applicant and spouse, if applicable) o Verification of Date of Birth (applicant and spouse, if applicable) o Verification of MCP (applicant) o A complet. [...] Yes No Declaration and Signature I declare that the information and answers given to the questions on this application are true to the best of my knowledge. [...] As stated in the Access to Information and Protection of Privacy Act (ATIPPA), all clients: “have the right to access their personal information that is held within the department and have the right to request the correction of their personal information if there has been an error or omission.” Responsibilities I agree to report any changes in my circumstances to the Prenatal – Early Childhood Nut. [...] Client Consent to Release and Exchange Personal Information I give consent to Children, Seniors and Social Development to obtain and verify information or documents required to confirm my eligibility for the Prenatal – Early Childhood Nutrition Supplement. [...] This information will be relevant to and will be used solely for the purpose of determining and verifying eligibility for, and the general administration and enforcement of the Prenatal - Early Childhood Nutrition Supplement Program.