FNS-699 The Integrity Profile (TIP) Report Form

FNS 699: THE INTEGRITY PROFILE (TIP) REPORT FORM

FNS-698 - OMB Form Number: 0584-0401

Contact Person:
First Name:

Last Name:

Enter Data

Enter Data

Phone:
Enter Data

Aggregate Data
Number of Vendors not selected during the Fiscal Year, due
to failure to meet selection and/or limitation criteria was:

Enter Data

Number of Vendors with scanners:

Enter Data

Number of Vendors with scanners that can identify WIC
Authorized foods versus non-WIC foods is:

Enter Data

Provide any other special information needed to clarify or interpret the TIP data:
Enter Data

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0401.
The time required for completing this collection is estimated to take 5 minutes per response, including
the time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and
reviewing the information collection.

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