| Wisconsin Department of Children and Families
Child Care Online Systems (CCPP/CSAW) Access Request for Agency Staff OnlyUse of form: This form must be completed and submitted to the DCF Service Desk in order to request access to the Child Care online systems. See complete instructions on reverse side.APPLICANT INFORMATIONRequested Action FORMCHECKBOX Activate User ID FORMCHECKBOX Delete User ID FORMCHECKBOX Change (type of access, etc.) Effective Date (mm/dd/yyyy) FORMTEXT ?????Organization Name / County / Tribe Applicant Represents FORMTEXT ?????Applicant Roles (Check all that apply) FORMCHECKBOX Pattern Access After Specific Person (use full name): FORMTEXT ????? FORMCHECKBOX Child Care Licensing FORMCHECKBOX Child Care Resource and Referral Agency FORMCHECKBOX W-2 Agency FORMCHECKBOX Child Care Certification FORMCHECKBOX Child and Adult Care Food Program FORMCHECKBOX State Staff (not DECE) FORMCHECKBOX DCF Staff Bureau FORMTEXT ???? FORMCHECKBOX Child Care Coordinator / Supervisor FORMCHECKBOX MiLES FORMCHECKBOX Child Support Agency FORMCHECKBOX Local Child Care Subsidy Agency FORMCHECKBOX FSET Agency FORMCHECKBOX Other Organization – Specify: FORMTEXT ?????Type of Access Requested FORMCHECKBOX CCPP (Child Care Provider Portal) FORMCHECKBOX CSAW (Child Care Statewide Administration on Web)Name of County(ies) / Tribe FORMTEXT ?????SECURITY INFORMATIONDWD / Wisconsin Login ID FORMTEXT ?????Secret Word (for security purposes) FORMTEXT ?????Applicant Name (Last, First, MI) FORMTEXT ?????Applicant Telephone Number (Work) FORMTEXT ?????Applicant Email Address (Work) – Print Clearly FORMTEXT ?????Use of this login and password provides access to confidential information, which must be safeguarded in accordance with Wisconsin Statutes. The User’s signature on this form constitutes acceptance of responsibility for compliance with §49.32(10), §49.32(10m), §49.81, §49.83 and §943.70(2) and with DWD policy (attached to new login approvals).SIGNATURE - ApplicantDate Signed FORMTEXT ?????Supervisor Name – (Print) FORMTEXT ?????Supervisor Telephone Number FORMTEXT ?????SIGNATURE – SupervisorDate Signed FORMTEXT ?????LOCAL AGENCIES ONLYReturn this form to your Local Child Care Coordinator for approval. The Coordinator will forward it to the Local Agency Security Officer. The Local Agency Security Officer forwards it to DCF Service Desk (dcfservicedesk@). You will receive an email notice when your access is approved.SIGNATURE – Child Care CoordinatorDate Signed FORMTEXT ?????SIGNATURE – County / Tribal Security OfficerDate Signed FORMTEXT ?????DCF SECURITY Name – DCF Security Officer (Print) FORMTEXT ?????Telephone Number FORMTEXT ?????SIGNATURE – DCF Security OfficerDate Signed FORMTEXT ?????INSTRUCTIONSCheck the appropriate box for the action you are requesting.Indicate the date by which you need to begin, change, or remove the access.Enter the organization name/County/Tribe you represent. Select Pattern Access After Specific Person and type in the full name of a user who has the access needed, or select all others that apply.Indicate the type of access you are requesting and include all Counties and Tribes you need to view or update. Indicate the User ID entered on the DWD / Wisconsin Account Creation screen—instructions can be found at . Enter your mother’s maiden name for security purposes.Enter your full name (Last, First, Middle Initial).Enter your work telephone number.Enter your work email address. Make sure to print clearly, so you receive an email notice once security has been approved.Sign and date the form.Present the form to the Child Care Coordinator/Supervisor for signature.Child Care Coordinator / Supervisor signs and dates the form; then sends it to the Local Agency (County/Tribal) Security Officer.The Local Agency (County/Tribal) Security Officer signs and dates the form, and then emails it to DCF Security. DCFServiceDesk@ (Please scan or photograph and email to DCF Service Desk.)DCF Security signs and dates the form. You (the applicant) will receive a notice via email when access is approved. ................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
- kinship care financial assistance application
- prince george s county covid 19 child care provider
- cfs 597 application for child care facility license
- ap 2 universal application for paad senior gold and
- applying for ddsn services home ddsn
- health care licensing application fl agency for health
- wisconsin department of children and families
- letterhead dhcaa badgercare plus enrollment