Racf ID LAN Request Form
Department of Health
Office for Information Technology Services
RACF/ID LAN/WAN Request
Add/Change/Delete
Date: Authorized Requestor / Sys. Admin.:
Phone Number:
Add: Change: (name/access/context, etc;) Delete: Current RACF
[pic]Employees starting in new program area MUST get a new RACF/ID
Request is for: State Employee Non State Employee
Regional Employee: County:
or
Local Employee: Program Area:
(Ex: BMF, CEDS, PPA, VR, COM, WIC)
Employee Name:
Last First M.
SSN: Effective Date:
Employee Phone#: FAX:
Address:
Floor Bldg. Street City Zip
Division: Fiscal Officer Signature:
Allotment Code: Cost Center: Speed Chart:
Establish User Accounts: NDS/GroupWise TN3270
Authorized AS400 use by:__________________________
Please Grant Group Membership(s) (specify context of group and access level)
List groups for AS400 & NDS & TN3270 (Drive Access levels)
The Employee has signed the Acceptable Use Policy as indicated
FAX TO 615-770-7466 Email form to Security.Health@
PH3743 Revised 07/09 RDA S836-1
-----------------------
(Office Use Only) RACF/ID:
Context:
................
................
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 searches
- annual credit report request form pdf
- dhs hearing request form michigan
- credit report request form pdf
- medical records request form pdf
- equifax annual credit report request form pdf
- idr plan request form 2019
- nycha transfer request form pdf
- mandatory forbearance request form 2019
- supply request form pdf
- office supply request form pdf
- supply request form army
- office supply request form template