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					                  General Instructions for Blackberry/Cellular/Air Card Request Forms

1    Complete appropriate form as indicated.
2    Attach justification for each position/person for whom a device/service is requested. Describe the job
     requirements that create a need for immediate access to the person and, if a BlackBerry is being
     requested, why a cell phone will not suffice. If DATA services or a SIM Card are requested, a detailed
     explanation of the need is required. Simple statements such as "we need to contact the person at any
     time" are not considered adequate justification: the specific job duties/responsibilities must be described.

3    Secure signature approval of the budget unit's fiscal officer.
4    Secure signature approval of the head of the budget unit, i.e. Assistant Secretary, Director, etc.
5    Attach DHH routing slip sheet to the request.
6    Make copy for your own records.
7A   OMF and Medicaid must submit requests to Sheila Moore for review. She will forward properly
     prepared requests to Mr. Castille for consideration.
7B   Program Offices and Other Entities must submit the request to the Deputy Secretary for review and
     possible approval. Properly prepared forms that are approved will be routed to the Undersecretary's
     Office for consideration. (Please note that his approval is not automatic: there may be larger budgetary
     issues to consider.)
8    Upon approval of the Undersecretary, the request will be forwarded to Susan Dean for processing


NOTES:
1    TRANSFER TO PERSON IN SAME POSITION: If an active BlackBerry or Cell Phone is to be provided to a
     "new" staff member who is occupying the same position as the person who used the device previously, the
     transfer is allowed without approval of Executive Management. However, the Change Form must be
     completed and sent to the Division of Contracts and Procurement Supports as notification of a change in
     "ownership." No justification is necessary as long as the position and the services remain the same. If
     device is inactive, see #3 below.
2    TRANSFER TO PERSON IN DIFFERENT POSITION: If the device is to be transferred to someone in a
     different position, then the Change Form must be submitted per instructions for approval. In this case, a
     justification must be attached.
3    ACTIVATION OF SPARE BLACKBERRY OR PHONE: The New BlackBerry/Cellular Request must be
     completed to activate any spare unit regardless of user. Approval for activation of spare units will be treated
     as a new request. (If using spare device to replace broken device, approval is not required. Complete
     Blackberry Change/Replacement Request and forward to Contracts and Procurement Support.)

4    ADDING/EXPANDING SERVICES: If a new service is to be added to a BlackBerry or cell plan minutes are to
     be increased, justification must be provided specific to the need for that service, and approval from Executive
     Management is required.

5    REDUCING SERVICES: No justification is required to reduce services and approval from Executive
     Management is not required. The Change Form is to be completed and routed directly to the Division of
     Contracts and Procurement Support.
6    STANDARD CELLULAR PLAN: The standard (or default) cellular plan for DHH employees allows up to 450
     minutes use per month. Requests for plans with a greater number of minutes will not be considered without
     detailed justification, except for staff in the following positions: DHH Secretary, Deputy Secretary,
     Undersecretary and Assistant Secretaries.
7    ISIS ORDER: Once a new blackberry or cellular device is approved, it will be the requesting offices
     responsiblity to enter a order in ISIS for the cellular services. The order must indicate in OMOD, the user
     of the device, the period covering and the type device (cellular only or blackberry). The requesting office
     must notify the Division of Contracts and Procurement Support of the order number established. No
     device will be released until the order is established in ISIS.
                                                  New BlackBerry/Cellular Request
Requesting Office and Contact Name/Number:                                                                                                                   Agency & Org #



Attach a separate sheet with specific justification for each position/person for whom a BlackBerry/cell is requested.

Note that the State of Louisiana may only purchase cell phones/BlackBerries for state employees. Such devices are not to be purchased for
or loaned to contractors, or other individuals who are not officially employed by state government.
Please note that while federal emergency funds (HRSA) may be used to purchase BlackBerries, the funds are not available for on-going service fees.


                                                                                                                                                    Blackberry Services




                                                                                                                                                                                      For Office of the SecretaryUse
                                                                                     Requested Device                                                   Requested




                                                                                                                                                                                      Only (Mark X if declined.)
                                                                                                        Blackberry/Cell Phone*
                                                                                                        Activate a spare



                                                                                                                                   New Cell Phone
                                                                                       New Blackberry




                                                                                                                                                                          Tethering
                                                                                                                                                              Voice
                                                                                                                                                     Data
             Name                              Title/Personnel #




* Provide IMEI and Pin #s for activation of spare blackberry device.        Provide IMEI for activation of spare phone. Add sheet if multiple spares
are to be activated.
                                                                           IMEI #                                                                    Pin #

By signing this document I am testifying to the availability of on-
going funding for the requested service fees within the Budget Unit.
                                                                                                                                 Approval of the Deputy Secretary and Date



Signature of Budget Officer and Date
                                                                                                                                 Approval of the Undersecretary and Date


Approval of the Assistant Secretary/Director and Date                                                                                                                 Rev 05/09
                                                              BlackBerry Transfer Request
                                                                                                                                                       Agency & Org #
                                  Requesting Office
Attach a justification if (1) the device is to be transferred to someone in a different position than the previous user and/or (2) an additional service is requested. Under
either of these conditions, Executive Management approval is required. Use New Blackberry/Cellular Request form if requesting activation of spare device.

A justification is not necessary if an active device is to be transferred to a person occupying the same position as the previous user and/or if services
remain the same or are reduced. Executive Management approval is not necessary for these types of actions, so in these cases you may route this form
directly to the Division of Contract and Procurement Support.
  Note that state-issued cell phones/BlackBerries are for state employees only. Such devices are not to be provided to or loaned to contractors, or other
                                             individuals who are not officially employed by state government.



                 Name of Previous User                       Title/Personnel #                        Name of Proposed User                        Title/Personnel #



     Does the Proposed User Occupy the Same                  Will the Service
          Position as the Previous User?                    Remain the Same?                                         Device Identification
            Yes                     No                       Yes          No                     BB/Cell #                   Pin #                        IMEI#



              Existing Voice Services (Complete on all requests.)                          Desired Voice Services (Complete only when change is requested.)
                      Plan Minutes                             Monthly Cost                                  Plan Minutes                            Monthly Cost



               Other Existing Services (Complete on all requests.)                         Other Desired Services (Complete only when change is requested.)
              Data                 Tethering                 Inactive                            Data                 Tethering               Inactive


                                                                                        Notes:
 By signing this document I am testifying to the availability
 of on-going funding for the requested service fees within
                     the Budget Unit.


Signature of Budget Officer and Date                                                    Approval of the Deputy Secretary and Date



Approval of the Assistant Secretary/Director and Date                                   Approval of the Undersecretary and Date

                              Contact Person/Phone
  Rev 05/09
                                                 BlackBerry Change/Replacement Request
                                                                                                                                                 Agency & Org #
                                 Requesting Office

This form is to be used to request service changes and/or a replacement to a previously approved blackberry. Do not use this form for transfer requests. When
requesting a replacement blackberry, the existing unit must be inspected by IT staff to insure that problem cannot be resolved. If a spare unit is available to use as
the replacement, check replace with spare unit and indicate IMEI# and PIN#. Forward request to Contracts and Procurement Support. Approvals are not necessary.

 Note that state-issued cell phones/BlackBerries are for state employees only. Such devices are not to be provided to or loaned to contractors, or other
                                            individuals who are not officially employed by state government.
                                                                                        √                     √                √                √

                                                                                            for Service        for SIM          for Device          to Replace w/
                     Name of User                          Title/Personnel #                 Change         Replacement       Replacement           Spare Unit**




                                                                                         Justify Need for Replacement (Attach detailed justification for any
                         Current Device Identification                                                          service increase.)
        Telephone #                  Pin #                        IMEI#



              Existing Voice Services (Complete on all requests.)                       Desired Voice Services (Complete only when change is requested.)
                     Plan Minutes                            Monthly Cost                         Plan Minutes                           Monthly Cost


                                 Other Existing Services (Complete on all             Other Desired Services (Complete      **Indicate IMEI# and Pin# if
                                                requests.)                             only when change is requested.)    replacing broken unit w/spare
                                       Data                 Tethering                    Tethering      Other (specify) IMEI#
                                                                                                                        Pin#

 By signing this document I am testifying to the availability
                                                                                     NOTES:
 of on-going funding for the requested service fees within
                     the Budget Unit.



Signature of Budget Officer and Date                                                 Approval of the Deputy Secretary and Date



Approval of the Assistant Secretary/Director and Date                                Approval of the Undersecretary and Date

                             Contact Person/Phone
  Rev 05/09
                                                 Cell Phone Transfer/Change Request                                                                          REV 03/27/09


                           Requesting Office

A justification must be attached if (1) the device is to be transferred to someone in a different position than the previous user and/or (2) an additional
service is requested. Under either of these conditions, Executive Management approval is required.

If an active device is to be transferred to a person occupying the same position as the previous user and/or if services remain the same or
are reduced, complete this form and route it directly to the Division of Contract and Procurement Support. Executive Management approval
is not necessary for these types of actions.

  Note that state-issued cell phones/BlackBerries are for state employees only. Such devices are not to be provided to or loaned to contractors, or
                                        other individuals who are not officially employed by state government.




              Name of Previous User                   Title/Personnel #                   Name of Proposed User                  Title/Personnel #



     Does the Proposed User Occupy the                Will the Service                                                         Is a new Cell Phone
     Same Position as the Previous User?             Remain the Same?                                                          Number Requested?
         Yes                  No                      Yes          No                       Cell Phone Number                     Yes         No



               Existing Services (Complete on all requests.)                     Desired Services (Complete only when a change is requested.)
                   Plan Minutes                     Monthly Cost                            Plan Minutes                   Monthly Cost




                                                                                 Notes:
    By signing this document I am testifying to the availability of
    on-going funding for the requested service fees within the
    Budget Unit.


    Signature of Budget Officer and Date                                                                 Approval of the Deputy Secretary and Date



    Approval of the Assistant Secretary/Director and Date                                                Approval of the Undersecretary and Date

                         Contact Person/Phone
Rev 05/09
                                                                   Air Card Request
Requesting Office and Contact Name/Number:                                                                                                               Agency & Org #



                         Attach a separate sheet with specific justification for each position/person for whom an air card is requested.

Note that the State of Louisiana may only purchase air cards/service for state employees. Such devices are not to be purchased for or loaned to contractors,
or other individuals who are not officially employed by state government. Air cards can only be used for official state business.




                                                                                                                                                                                For Office of the SecretaryUse
                                                                            Requested Device Air Card Services Requested




                                                                                                                             Service Plan/Monthly Cost




                                                                                                                                                                                Only (Mark X if declined.)
                                                                               Internal Device




                                                                                                                                                             Service Provider
                                                                                                                                                             Requested
                                                                                                          PC CARD
                                                                                                  USB
            Name                           Title/Personnel #




                                                                                                 NOTES:
By signing this document I am testifying to the availability of on-
going funding for the requested service fees within the Budget Unit.




Signature of Budget Officer and Date                                                                                Approval of the Deputy Secretary and Date



Approval of the Assistant Secretary/Director and Date                                                               Approval of the Undersecretary and Date


Rev 05/09
                                                                Air Card Transfer Request
                                                                                                                                                       Agency & Org #
                                  Requesting Office

Attach a justification if (1) the device is to be transferred to someone in a different position than the previous user and/or (2) an additional service is requested. Under
either of these conditions, Executive Management approval is required.
A justification is not necessary if a device is to be transferred to a person occupying the same position as the previous user and/or if services remain the
same or are reduced. Executive Management approval is not necessary for these types of actions, so in these cases you may route this form directly to the
Division of Contract and Procurement Support.
    Note that state-issued air cards are for state employees only. Such devices are not to be provided to or loaned to contractors, or other individuals who are not
                                                                officially employed by state government.



                Name of Previous User                        Title/Personnel #                        Name of Proposed User                        Title/Personnel #



     Does the Proposed User Occupy the Same                  Will the Service
          Position as the Previous User?                    Remain the Same?                                         Device Identification
            Yes                     No                       Yes          No                  Telephone #                               FCC ID#




                  Existing Services (Complete on all requests.)                                Desired Services (Complete only when change is requested.)
                      Plan Minutes                             Monthly Cost                                 Plan Minutes                             Monthly Cost



                                                                                        Notes:
By signing this document I am testifying to the availability of on-going
    funding for the requested service fees within the Budget Unit.


  Signature of Budget Officer and Date                                                  Approval of the Deputy Secretary and Date




  Signature of Assistant Secretary/Director and Date                                    Approval of the Undersecretary and Date

                              Contact Person/Phone
  Rev 05/09

				
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