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					                                 Remote Request for DHS Applications

Please answer the following questions, save the document, and return it via email to
DHS.Servicedesk@state.or.us with copy to Rhonda or Ryan.

Fields marked Required must be filled in order for an account to be created.
1. Name (Last, First MI) (Required):
2. Email Address (Required):
3. Job Title/Description:
4. Are you a State of Oregon DHS Employee? (Required)
      If yes, what is your Oregon ID (as it is listed on your pay stub)?
5. Are you State of Oregon DHS Partner? (Required) YES
      If you already have a Partner ID please list here:
6. What Agency, Organization or Company do you work for? (Required)
7. Phone Number (Required):
8. Physical Address (Required) :
9. City (Required):
10. Zip code (Required):

11.   Do you have your supervisor’s approval? (Required) YES
12.   Supervisor’s Name (Required):
13.   Supervisor’s Phone Number (Required):
14.   DHS Business Liaison Name (Required for DHS Partners): SEE Q15 BELOW

15. DHS Business Liaison Phone Number ( Required for DHS Partners):
         RHONDA BUEDEFELDT 503.373.1854 rhonda.buedefeldt@state.or.us
                                       and
               RYAN KIBBY 503.373.1877 ryan.e.kibby@state.or.us

16. Do you need Remote Access to the DHS Mainframe? YES

17. Do you need remote access to TRACS, CSTAT, FACIS, OACCESS, ORCA5,
EDMS or FAMILYNET? YES Which one(s)? OACCESS & OACCESS Training
      17a. Do you download client files to your laptop so you can access them while
           in the field? N     Y, my IP address is         .     .     .     *
             (Find your IP address here: http://whatismyipaddress.com/)
18. Do you need remote access to any other DHS Applications, and which ones?
*Service Desk – As per Tom Holland – the IP Address is required if the end-user has a laptop and
wishes to check out client files and consolidate into OACCESS upon returning to the offices.

C:\Docstoc\Working\pdf\0302dfa8-b335-4eec-b64e-097972f49bd6.doc
Updated 3.29.2010
                                                                    Completed request on: 1/24/2011 9:03 PM

				
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Description: Download Pay Stub Template document sample