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Complete All Sections
All sections of FNS Form-698 must be completed and submitted each fiscal year. Once submitted, the form can no longer be
changed. A new Form FNS-698 will be available for the next fiscal year.
OMB APPROVED NO. 0584-0401
Expiration Date:XX/XX/XXXX
PROFILE OF INTEGRITY PRACTICES AND PROCEDURES (PIPP)
SECTION 1: Vendor Selection, Limitation and Authorization
FI = Food Instrument
CVV = Cash-Value Voucher
1. The State Agency limits the number of vendors it authorizes:
2. Vendor applicants are notified of authorization within how many days of initial submission?
3. The State Agency contracts with vendors:
Check only one box
On an on-going basis
Annually
Every 2 years
Every 3 years
Other (specify below)
Other time period:
4. The WIC Program uses standard selection criteria for evaluating vendors which include:
Check all that apply
Minimum variety and quantity of authorized supplemental foods
Competitive prices
Lack of a record of criminal conviction or civil judgement for specified activities
Lack of a history of serious vendor violations
Lack of a history of serious Supplemental Nutrition Assistance Program (SNAP) violations
Must be SNAP authorized
Not currently disqualified from SNAP
Must provide a variety of food other than WIC supplemental foods
Must obtain infant formula only from the sources on the State Agency's list of infant formula wholesalers,
distributors, and retailers, licensed under State law/regulations and manufactures registered with the Food
and Drug Administration
Must obtain prior approval to provide incentive items to WIC participants if the store derives more than 50
percent of its annual food sales revenue from WIC FI's
Other (specify below)
Other criteria used:
5. Each vendor's prices are monitored to ensure that redemptions do not rise to a level that would make the vendor
ineligible for authorization:
6. On-site visits are performed to verify information received during the authorization process.
Check only one box
For new vendors only
For new vendors and for previously authorized vendors
Public reporting burden for this collection of information is estimated to average 10 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-698 (12-08) Previous Editions Obsolete
SBU
Electronic Form Version Designed in Adobe 10.0 Version
Page 1
PIPP - Continued
SECTION 2: Pre- and Post-Payment Edit Systems
FI = Food Instrument
CVV = Cash-Value Voucher
1. The State uses pre-edit (before payment) or post-edit (after payment) screens for:
Check all that apply
All FI's and CVV's
Pre-Edit
Post-Edit
Not applicable
Sampled FI's and CVV's
Pre-Edit
Post-Edit
Not applicable
Other:
Other:
Pre-Edit
Post-Edit
Not applicable
Percent of sampled FI's and CVV's:
%
2. The State Agency screens FI's and CVV's through a pre-edit (before payment) or a post-edit (after payment)
process to detect the following:
Check all that apply
No WIC agency validation stamp
Pre-Edit
Post-Edit
Does not screen
No vendor stamp
Pre-Edit
Post-Edit
Does not screen
Illegible vendor stamp
Pre-Edit
Post-Edit
Does not screen
Invalid vendor stamp
Pre-Edit
Post-Edit
Does not screen
Counterfeit vendor stamp
Pre-Edit
Post-Edit
Does not screen
Invalid vendor number
Pre-Edit
Post-Edit
Does not screen
Canceled vendor number
Pre-Edit
Post-Edit
Does not screen
Vendor number not on file
Pre-Edit
Post-Edit
Does not screen
Post date (cashed before 1st date of use)
Pre-Edit
Post-Edit
Does not screen
Stale date (cashed after end use date)
Pre-Edit
Post-Edit
Does not screen
Altered date
Pre-Edit
Post-Edit
Does not screen
Altered signature
Pre-Edit
Post-Edit
Does not screen
No signature/counter signatures
Pre-Edit
Post-Edit
Does not screen
Mismatch signature
Pre-Edit
Post-Edit
Does not screen
Excessive dollar amount (fill in amount below)
Pre-Edit
Post-Edit
Does not screen
Altered dollar amount
Pre-Edit
Post-Edit
Does not screen
Dollar amount in pencil
Pre-Edit
Post-Edit
Does not screen
Illegible dollar amount
Pre-Edit
Post-Edit
Does not screen
No dollar amount
Pre-Edit
Post-Edit
Does not screen
No participant name
Pre-Edit
Post-Edit
Does not screen
FI or CVV submitted late for payment
Pre-Edit
Post-Edit
Does not screen
Excessive dollar amount:
%
Leave blank if State does not screen
Page 2
PIPP - Continued
SECTION 3: Food instruments
FI = Food Instrument
CVV = Cash-Value Voucher
1. The FI and CVV used is:
Check all that apply
CHECK
(a negotiable FI or CVV which is processed for payment through the vendor's bank)
VOUCHER
(a non-negotiable FI or CVV which is processed for payment through the State Agency)
DRAFT
(a negotiable FI or CVV which is processed for payment through a fiscal intermediary)
EBT CARD
2. FI's and CVV's are generally issued:
Check only one box
Monthly
Every 2 months
Every 3 months
Other (specify below)
Other time period:
3. Average number of FI's and CVV's:
Enter the average number of food instruments issued per participant per month:
4. The maximum value on the FI's is hidden:
5. FI's and CVV's are routinely mailed to participants:
Mailed statewide or in certain areas on a routine basis. (Do not check Yes if FI's are routine mailed for inclement weather)
Page 3
PIPP - Continued
SECTION 4: Sanctions
FI = Food Instrument
CVV = Cash-Value Voucher
1. The State Agency uses a point system in sanctioning vendors
2. Vendors who are disqualified but who subsequently request an administrative hearing:
Check only one box
May accept WIC FI's and CVV's during the appeal process
May not accept WIC FI's and CVV's during the appeal process
Determined on a case-by-case basis
SECTION 5: Vendor Relations
1. The State Agency meets with representatives from retailer associations to resolve problems and solicit ideas on
improvements in WIC program operations.
Check all that apply
At least once a year
Every 2 years
Once every 5 years
Less frequently than every 5 years
As needed
SECTION 6: Compliance Buy Procedure
1. Check below the types of Compliance Buys conducted when a suspect vendor is investigated:
Check all that apply
Trafficking (exchange of FI's or CVV's for cash)
Always
Sometimes
Never
Sale of non-food items
Always
Sometimes
Never
Sale of unauthorized/excessive food items
Always
Sometimes
Never
Sale of alcohol/tobacco
Always
Sometimes
Never
Safe Buy (alll FI's or CVV's purchased to see if vendor
will overcharge)
Always
Sometimes
Never
Partial Buy (not purchasing all FI's or CVV's to see if
vendor will charge for food not purchased)
Always
Sometimes
Never
2. Compliance buys are usually conducted by:
Check all that apply
Neighborhood residents or program participants employed by WIC
Local WIC Agency staff
WIC State Agency subdivision/region staff
WIC State Agency staff
Other State Agency staff
Investigators retained on a contract basis
Law enforcement bodies
Page 4
File Type | application/pdf |
File Modified | 2014-08-14 |
File Created | 2014-08-14 |