NCAS SECURITY REQUEST FORM OSC FORM SEC01

AGENCY REQUEST / OSC USE ONLY
AGENCY #: ______DIV NAME: ______
REGION: _____
FOR SECURITY CONTROLS/MODIFICATIONS ATTACH A SEC02 FORM FOR EACH APPLICATION REQUESTED IF COPYING A STATEWIDE SECUIRTY PROFILE. / OPERATOR ID #:
(PASSWORD MUST BE CHANGED BY THE OPERATOR DUING THE FIRST LOGON TO THE SYSTEM)
TYPE OF REQUEST:
A = ADD OPERATOR C = CHANGE OPERATOR
D = DELETE OPERATOR N = CHANGE NAME AND PASSWORD ONLY
OPERATOR ID #:
OPERATOR NAME: ______/ OSC SECURITY SIGN-OFF
DCI SECURITY COMPLETED BY:
______/____/_____
(DCI Security Administrator’s Signature) (Date))
RACF ID: ______RACF GROUP: ______
OPERATOR’S PHONE NUMBER: ______
OPERATOR’S EMAIL ADDRESS: ______/ IE SECURITY COMPLETED BY:
______/____/_____
(IE Security Administrator's Signature) (Date)
SELECT SYSTEMS TO BE ACCESSED
Application Security Profile or SEC02
# Name Operator ID to copy Attached / CHECK BOX FOR COMPLETION
03 GL ______
04 AR ______
06 AP ______
07 IN ______
08 FA ______
09 BC ______
Does operator have END approval? Y N
49 PC ______
14 PS ______
21 FC ______
I.E. ACCESS (YES) COMPLETE OSC SEC04
The security request above complies with my agency’s internal controls (separation of duties) and policies to prevent security abuses. The operator above has also reviewed the NCAS Security Policy located on the OSC’s Website.
REQUESTED BY: ______
(Print Name of Agency Security Administrator)
Security Administrator’s Phone #: ______
Security Administrator’s Email: ______
______/_____/_____
(Agency Security Administrator's Signature) (Date) / APPLICATION SECURITY COMPLETED BY:
NCAS: HEAT: USRT:
.RS:
DATE: ______

IF YOU HAVE QUESTIONS ABOUT THIS FORM, CONTACT THE OSC SUPPORT SERVICES CENTER AT (919) 707-0795. REV: 03/17