FNS-700, pg. 1 TIP Data Entry Form

FNS 700: TIP DATA ENTRY FORM

FNS 700 - OMB Form Number: 0584-0401

Add Vendor Information
Required entries are indicated by an asterisk (*)
Verify FNS Number
An FNS number may exist for this Vendor. To verify a number or determine if a number exists,
click Find FNS Number, which allows you to search for FNS Stores. If you select a store from
the search results, the FNS 700 Form redisplays with the FNS Number and the store location
address copied to the appropriate fields. You can edit the data, if needed.

*Vendor ID:
Enter Data

Enter a valid FNS number below. To associate the FNS number to the Vendor, click Save.
Leave blank, if there is no FNS number.
FNS Number:
Enter Data
New Vendor:

*Vendor Name

Yes
No

Street Number:
Enter Data

Enter Data

No Training

Enter Data

Routine Monitoring Visits:

No Training
Annual - A
Interactive - I

Additional Address:
Enter Data

*City:

*State:

Enter Data

Select One

Enter Data

*Type of Vendor:
Select One

Vendor Agreement:

Zip + 4 Code:

Enter Data

Enter Data

Redemption Months:

*Training:

Street Name:

*Zip/Postal Code:

Annual Redemptions:
$

Select One

Enter Data

Select One

Enter Data

Terminated - T
Expired - E

Retail Vendor - R
W - WIC -only Retail Vendor - W
Above 50% Vendor - A
Commissary - C
Pharmacy - P
Home Food Delivery Contractor - H
Direct Distribution Center- D

Compliance Information
If you select On-Going for any Investigation, enter data for either (1) Compliance Buys or (2) Inventory Audits.
If you select Completed for any Investigation, (1) indicate at least one Indicator and (2) select a Reason for Sanction below.
Compliance Investigation:
Select One

Initiated - I
Completed - C
On-Going - O

Investigations by Other Entity
Select One

Initiated - I
Completed - C
On-Going - O

Number of Compliance Buys:
Enter Data

*Risk Designation:
Select One

High Risk
Non-high Risk

Date Referred to FSP:
If date is entered, Type of Sanction (below) must be set to Disqualified or CMP.
Month:
MM
Day: DD
Year: YYYY

Number of Inventory Audits:
Enter Data

Indicator Information
Redemption Indicators:
A - Extremely small amount of variation in food instrument prices - the individual food instrument prices do not vary
substantially from the average price
B - Large percent of food instruments redeemed at same price
C - Unusually high average food instrument prices - submitting extremely high average food instruments compared
with similar vendors
D - Redeemed prices are higher than their price list

Volume Indicators:
E - Large percent of high-priced food instruments
F - Volume of WIC business
G - Large increase of dollar volume of food instruments redeemed over time
H - Large percent of the area’s total WIC redemptions
I - WIC sales are an unusually high percentage of vendor’s total sales
J - High WIC to Food Stamp redemption ratio
K - WIC and Food Stamp sales are an unusually high percent of total sales

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