Section I requestor information




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Network and Email (AMD)
Individual User Profile (IUP 786)



Section I

Requestor information

Name (print): First M.I. Last

     


Phone:
    -     -      

Email address:

     


Individual user profile (“user” is the person whose account is being affected)

Check all that apply:

 Add a new user ID  Change name on user ID

 Modify access or move  Needs network account

 Revoke a user ID  Needs email account


Employed by:

 DHS|OHA branch no./location:

     

 Contractor:

     

 Other (specify):

     









Individual user new information (include floor or suite number when applicable)


Name (print): First M.I. Last

     


User ID:

     


Effective date:

     


Agency name:

     


Position/title:

     


Phone:

    -     -      Extension:      



Fax:

     -      -     



Employee ID number:

     


Work address – Street address: City State ZIP
     

Floor:
     

Cubicle:
     

Individual user old information (include floor or suite number when applicable)

Name (print): First M.I. Last

     


User ID:

     


Effective date:

     


Agency name:

     


Position/title:

     


Phone:

    -     -      Extension:      



Fax:

    -     -     



Employee ID number:

     


Work address – Street address: City State ZIP
     

Floor:
     

Cubicle:
     

Manager information

Name (print): First M.I. Last

     


Today’s date:

4/14/2016

Phone:

    -     -      Extension:      



Email:

     


Use this link for access to Information Systems for the following agencies:

CAF-CW DHS 0783CW

CAF-SS DHS 0783SSP / SPD DHS 0784 / EDMS-NM DHS 0780NM



Section II

Email distributions lists and shared file access

Please specify someone with a similar job role that can be used as a model for Outlook and folder/file access. Be careful not to use someone who might have more access than this employee will need – like a manager.


First name:

     

Middle initial:

     

Last name:

     



Systems access requested (Attach additional pages as needed)


Shared folder groups / file server groups

E-mail distribution lists (Outlook)

     

     

Comments:      


For new hardware or licensed software requests, please follow the IT request process located at: Computer.Request@state.or.us. It may take up to 3 weeks to process an IT request. This IUP form is not used to order equipment or software.



Annual IUP

At a minimum, the assignment of IUP computer access will be revisited annually to ensure accuracy. As employees change positions or work assignments, review computer system access to ensure that appropriate access is maintained or revoked. When necessary, complete a new IUP.




Signature:


Date

  /  /  



Comment:     

Signature:


Date

  /  /  



Comment:     

Signature:


Date

  /  /  



Comment:     

Signature:


Date

  /  /  



Comment:     



Administrator use only


Dates completed:

User ID(s) assigned:   

Disabled:   /  /  



Notification sent:   /  /  

Created:   /  /  


Please e-mail the completed form to the OIS Service Desk at the following e-mail address:



Dhs.servicedesk@state.or.us


Page of MSC 0786 (08/15)


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