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Participant Access Assessment (PAA) Form Attachment #1, 8.03

Revised May 2018

Vendor Management Unit Staff

Vendor Manager Assessment Completed By: _______________________________________ Date: ________ Approval Completed By: _______________________________________ Date: ________ WIC Vendor Manager or designee to complete the following questions: 1. Local Agency Response included/attached: Yes □ or No □ or Not Applicable □

2. State WIC Office Findings: Inadequate Participant access would exist: Yes □ or No □

3. Map(s) Provided: Yes □ or No □

4. Administrative Attachments: Yes □ or No □ or Not Applicable □

5. Comments: 7. Has the State Office received two or more complaints within the last twelve months re: procedural errors and/or customer service issues concerning other authorized Vendors serving the county? Yes □ or No □ 8. Local Agency consulted? Yes □ No □ or N/A □ Person Contacted: _________________________________ 9. Comments:

Attach separate page for additional comments if necessary