FNS-699 The Integrity Profile (TIP) Report Form

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THE INTEGRITY PROFILE (TIP) REPORT FORM

FORM APPROVED OMB NO. 0584-0401

Contact Person:
First Name:

Last Name:

Phone:

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

Number of Vendors with scanners:

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

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

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and
Nutrition Services, Office of Research, Nutrition and Analysis, Room 1014, Alexandria, VA 22302. Do not return the completed form
to this address.

Form FNS-699 (12-08) Previous editions are obsolete

SBU

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