User Name: RACF ID:


Senior and People with Disabilities
Information Systems Coordination Unit / APD - Individual User Profile

Section l – Individual user profile (“User” is the person whose account is being affected.)

Check all
that apply: / Add a new user ID Revoke a user ID (temporary revoke/leave of absence)
Modify access ***Be sure to designate which roles are to be added/deleted.
Failure to do so will result in all previous roles being deleted***
Keep all previous roles
Terminate a user ID (no longer with the agency)
Change name on user ID (new user ID will not be issued for name changes.)
Employed by:
Permanent
Temporary / DHS/AAA branch no: District
Contractor Agency/Business Name:
AAA Name:
Employment Status (FT, PT, Rotation, Limited Duration)
OtherAgency(specify):

Individual User Information (Include floor or suite number when applicable)

Name: (print) (First) (M.I.) (Last) / RACF ID / Effective date:
Branch/Unit Name: / Position/Title:
E-mail address: / Phone:
() - / Extension: / Employee ID number:
Work address: / City: / State: / ZIP:

NON-DHS User Information (Includes Contractors/Partners, Volunteers, etc.)

Name: (print) (First) (M.I.) (Last) / RACF ID: / Effective date:
Access Agreement (AA) Number: / Position/Title:
E-mail address: / Phone:
() - / Extension: / Partner ID:
Work address: / City: / State: / ZIP:

Manager information

Name: (print) (First) (M.I.) (Last) / Today’s date:
January 29, 2019
Branch/Unit Name: / Phone:
() - / Extension: / Position/title:
Manager’s Signature: / E-mail:

File: Original in local user file DHS 784 (11/16)

Page 1 of 11

User Name: RACF ID:

User name:RACF:

APD mainframe user groups

Add / Del / User Group / General Field and Central Office User Groups
SSUALL / APD FORMS SYSTEM GROUP - Permits access to Mainframe Forms (FBLD, FBOS, FREQ)
SSUAPLUP / A TYPICAL PROVIDER LIMITED TO AD - Permits access to AATH, APAY screens (AATH, APAY)
SSUCBCIQ / JD-CBC INQUIRY USER GROUP - Permits access to claim details, earnings summary, CBC Payment system (DCLM, DISB, PESM, PRAD, RATZ, SADD, SCFD, SCFH, SCLM, SERF, SMRF, SMRQ, SNRS, SPVB)
SSUCLTIQ / CLIENT HISTORY INQUIRY - Permits access to case and person history, suspense records (WLGC, WLGH, WLGR, WSUS)
SSUCSPIQ / CHILD SUPPORT PROGRAM SCREENS -Permits access to Info regarding parents, caretakers, children, employer, and case status; Direct deposit and EFT transactions on a case (SAPD, SAPH, SESR, SJ7F, SMCL, SMEH, SMIC, SMR1, SMSD, SMUA, SMUX, SMU1, SOPA, SOYA, SPOP, SPTD, SPTH, SRCI, WPAY)
SSUCSRCH / APD OREGON ACCESS SEARCH (You do not need this group if you have SSUFIELD.) Permits access to (ELGI, SCMS, SCP1, SCP2, SCP3, S012, S013, S014, S015, S016, S100, S105, S106, S185, WEBM, W026, W027, W029, W030, W031, W032, W091, W092, W109, W110, W130, W133, W141, W147, W157, W158, W160, W213,W215, W222, W226, W228, W229, W230, W231, W232, W233, W234, W235, W236, W240, W241, W242, W243, W244, W245, W246, W247, W248, W249)
SSUDDELI / DD ELIGIBILITY INQUIRY - Permits access to view eligibility screens (SLEI, SLEQ, SLLI, SLWQ)
SSUFIELD / APD FIELD WORKER GROUP - Permits access to read rights to multiple screens
SSUHDVSR / HEALTH DIVISION VITAL STATS RECORDS - Permits access to marriage and divorce records (BABD, BABH, BABW, BMBD, BMBH, BMBW)
SSUHKINQ / HOUSEKEEPER INQUIRY GROUP - Permits access to CEP financial information, CEP voucher list/details, in-home service and claims, CEP respite hours, CAPS service Eligibility, provider union deduction and voluntary deduction information (HDTL, HFIQ, HINQ, HINV, HPAD, HRDY, HRSP, HSVC, SCEI, SCOI, SCRI, SELG, SHHW, SHLQ, SOTD, SOTI, SSEQ, SUDI, SVDA, SVDD, SVDH, SVDM)
SSULISUP / SSA LOW INCOME SUBSIDY DATA - Permits access to (SLD1, SLD2, SLIL, SLIQ)
SSUMEDIQ / MEDICAID CLAIMS INQUIRY -Permits access to creditor check detail, liability financial transaction, voucher information, earnings summary, CBC adjusted claims history, Liability setup, provider recoupment, creditor name brows screen (DCLM, DCRD, DLIA, HDTL, HFIQ, HINQ, HINV, HSVC, PESM, PRAD, PRV8, SCLM, SCRD, SCRI, SLIA, SOTD, SOTI, SPRI, SPRQ, SPVF, SPVM, XCRD)
SSUPROIQ / PROVIDER INQUIRY USER GROUP -Permits access to Provider file information (RCIQ, PRV8, SPVF, SPVM)
SSURCUPI / PROVIDER RECOUPMENT INQUIRY -Permits access to list and details of payment records and return checks (SPRI, SPRQ)
SSUSEINQ / SERVICE ELIGIBILITY INQUIRY-Permits access to eligibility and service benefits, service category information, client assessment data, CAPS service eligibility (SELG, SL01, SL02, SL04, SSEI, SSEQ)
SSUSSA / APD SOCIAL SECURITY ADMINISTRATION - Permits access to SSA demographic, resource, unearned income information, TPQY requests, and specific SSN data. (BEIN, BEUP, WDE1, WDE2, WQTR, WQY1, WQY2, WQY3, WR01, WR02, W035, W036, WO37, W038, W075, W076, W077, W108, W203, W204, W205, W206, W207, W208, W209, W210, W211)Should ONLY be permitted to users who DETERMINE Eligibility.
SSUTAINQ / T&A INQUIRY SCREENS – Permits access to (STAM, STA1, STA5, STA6, STA8)
APD mainframe user groups cont.
The following user groups allow staff access to high-level changes, therefore, these rights should only be given to individuals that require it for specific job duties:
Add / Del / User Group / High Level Access Groups
/ SSUHKOPI / OPI PAYMENT- Permits user to generate and pay Oregon Project Independence Vouchers (OATH, ONGO, ONIQ, OPAY,SLVI, STIM, STIQ, SVCH)Should NOT permit to any user with CAPS 2 Update -OPI Type, OAA/OPI General Update or XIX Provider Maintain.
SSUHKPAY / APD HOUSEKEEPER MEDICAID PAYMNT AUTH GROUP - Permits access to (HATH, HDTL, HPAY, ONGO, ONIQ, SLVI, STIM, STIQ, SVCH) Should NOT permit to any user who has rights to Oregon ACCESS user group XIX Provider Maintain
SSUHKVHR / HK VOUCHER ISSUE- Permits access to (HATH, ONGO, ONIQ, SLVI, STIM, STIQ,SVCH) Should NOT permit to any user who has rights to the OREGON ACCESS User group XIX Provider Maintain.
SSUJFRC / APD PAY IN SYSTEM RECEIPTING GRP- (The transactions are in SSUFIELD user group, but in order to update this group is also needed.)Should NOT permit to any user who has rights to SSUJFUP
SSUJFUP / APD SYSTEM UPDATE GROUP-(The transactions are in SSUFIELD user group, but in order to update this group is also needed) Should NOT permit to any user who has rights to SSUJFRC
SSUSPL / APD SPECIAL CASH PAY AUTH GRP- Permits access to (SPLS, SPL1, SPL2, SPL3, SPL5, W105, W125)
SSUTAAPV / T&A PAYMENT APPROVAL -Permits access to (STA7). Should NOT permit this user group to anyone who has rights to SSUTAUPD.
SSUTAUPD / T&A ACCT MAINTAIN & PAYMNT RQST SCRNS-Permits access to (STAM, STA1, STA2, STA4, STA5, STA6, STA8) SHOULD NOT permit this user group to anyone who has rights to SSUTAAPV.
Add / Del / User Group / Specialized Field Office Roles
SSUDDUPD / DDFT UPDATE GROUP - Permits access to (DDFI, DDFT, PRV8, SPVF)
SSUEBCRD / EBT CARD ISSUE/MAINTENANCE GRP (Issue/Maintain EBT Card) - Permits access to Display EBT card information (W101)
SSUEBFSC / EBT FOOD STAMP CONVERSION GROUP (Convert food stamps to cash) - Permits access to Displays EBT card primary payee, benefits, balances, and usage information (W100, W102, W103, W104, W227, W250, W251)
Add / Del / User Group / Specialized Central Office Roles
APD
SSAUSER / APD TSO LAY USER GROUP - Permits to access TSO (RMPJ, RMRA, RMRI, RMRL)
SSCAPDUP / APD SERVICE ELIGIBILITY UPDATE - Permits access to History Eligibility screens (SL04, SSEU,SSQ1)
SSCAPPAY / ATYPICAL PROVIDER PAYMENT UPDATE - Permits access to SATH and SPAY (SATH, SPAY)
DD Council
SSUDDICC / OREGON COUNCIL ON DEVELOPMENTAL DISABILITIES INC - Permits access to provider information and claims both medical and non-medical. (DPCD, DPCM, DPCR, DPCS, DPNR, DPPI, DPPL, DPPM, DPPQ, DPPS, DPSD, RCIQ, UCMS, WCCS, W021)
SSCCENT / SPDCENTRAL OFFICE GROUP - Permits access to Long Term Care File Provider Extract (HNFR)
OLRO / CIHS
SSCCWSVC / CHILD WELFARE SERVICES INFO FOR CIIS STAFF - Permits access to determine if AFS & CSD cases are located on central client index as well as case information, referrals, and basic provider information. (ICDA, ICDB, ICDL, ICDM, IPDB)
SSMHPAY / APD MENTAL HEALTH HOUSEKEEPER PAY GROUP - Permits access to authorize and pay mental health services (HATH, HDTL, HFIQ, HINQ, HPAD, HPAY, HRDY, HSVC, ONGO, ONIQ, SLVI, SOTD, SOTI, SPVF, STIM, STIQ,SVCH)
APD mainframe user groups cont.
Add / Del / User Group / Specialized Central Office Roles cont.
Children’s Res / DDS / Central Delivery Services
SSCDIVEU / DD ELIGIBILITY IVE UPDATE - Permits access to update DD Eligibility screens, including LOC. (SLEI, SLEQ, SLFE, SLFU, SLLI, SLWQ)
SSCDIVEI / DD ELIGIBILITY IVE INQUIRY - Permits access to view DD Eligibility Screens (SLEI, SLEQ, SLFE, SLLI, SLWQ)
SSCBCEXC / CBC EXCEPTION AUTHORIZATION - Permits access to inquiry, query and update CBC Exception Authorizations (SRXI, SRXQ, SRXU)
Home Care Commission
SSCHCCIQ / HOME CARE COMMISION PROVIDER INQ SCREENS - Permits access HCW financial information as well as MMIS medical information (HDTL, HFIQ, HINQ, HINV, HRSP, HSVC, PRV8, SCRI, SHHW, SHLQ, SOTD, SOTI, SPVF, SRTI, SRTM, SUDI, SVDA, SVDH, SVDM)
Provider Relations
SSCACCT / APD ACCOUNTING PAYMENT EXPENDITURES - Permits access to payments issued (RCIQ, WCRU, W180, W181, W183)
SSCBCMHD / MH/DD CBC 512 AUTHORIZATION - Permits access to client and provider information for CBC 512 payments (DCLM, DCRD, DISB, DLIA, FNAR, MRAT, PCIQ, PESM, PRAD, PRV8, RATZ, SADD, SADJ, SBEG, SBIF, SCAU, SCFD, SCFH, SCFP, SCFS, SCLM, SCRD, SERF, SLIA, SMCU, SMCV, SMRF, SMRQ, SMSG, SNRS, SPVB, SRXI, SRXQ, XCRD)
SSCCBCUP / CBC UPDATE - Permits access ability to update information in CEP payment screens (ADPY, PCRD, SADJ, SBIF, SMCU, SMCV, SMEU)
SSCUNION / UNION DEDUCTION/EXCLUSION AUTH UPDATE - Permits access to update union deduction/exclusion authorizations (SAFQ, SPBU, SUDU, SUEU)
SSCWKR / WORKER TABLE (LOAD CODE) GROUP - Permits access to update load code tables (SWKR)
SSMHPAY / APD MENTAL HEALTH HOUSEKEEPER PAY GROUP - Permits access to authorize and pay mental health services (HATH, HDTL, HFIQ, HINQ, HPAD, HPAY, HRDY, HSVC, ONGO, ONIQ, SLVI, SOTD, SOTI, SPVF, STIM, STIQ, SVCH)
ITBS
SSCCIMRG / CI MERGE - Permits access to screens that allow update to merge accounts (W097, W107, W166, W221)
SSCDB2TB / VIEW PROVIDER DB2 TABLES -Permits access to DB2 tables.
SSCDDSEU / DD SERVICE ELIGIBILITY UPDATE - Permits user to DD Eligibility screens as well as History of these screens (SELG, SL03, SL04, SL05, SSQ1)
SSCACCT / APD ACCOUNTING PAYMENT EXPENDITURES - Permits access to payments issued (RCIQ, WCRU, W180, W181, W183)
SSCAMHPC / AMH PAYMENT PROCESSING - Permits access to HCW information and voucher payments (HDTL, HFIQ, HINQ, HINV, HPAD, HPAY, HRDY, HRSP, HSVC, MATH, MPAY, ONGO, ONIQ, PRV8, SCEI, SCRI, SELG, SHHW, SHLQ, SLVI, SLO2, SOTD, SOTI, SPVF, SPVM, SSEQ, STIM, STIQ, SUDI, SVCH, SVDA, SVDD, SVDH, SVDM)
SSCELGRU / ELIGIBILITY UPDATE GROUP - Permits access to (PRV8, SPVF, SLMU)
SSCELGUP / DD ELIGIBILITY ALL UPDATE -Permits access to update DD Eligibility screens (SLEH, SLEI, SLEQ, SLEU, SLE1, SLFE, SLFU, SLLH, SLLI, SLLU, SLL1, SLPQ, SLPU, SLWQ, SLWU)
SSCLNTUP / CLIENT HISTORY UPDATE -Permits access to Update MMIS screens WFTMMIS (WLGC, WLGH, WLGR, WSUS)
SSCPVMRG / PROVIDER MERGE SCREEN - Permits access to merge provider screens (SPVJ)
SSCREFTB / APD REFERENCE TABLE - Permits access to (SENH, SRDH, SRDM, SRTI, SRTM, SRTU)
SSCRESND / RESEND SERVICE ELIGIBILITY RECORD - Permits access to (SELG, SL01, SL02, SL04, SL06, SSEI, SSEQ, SSER, SSQ1)
SSCTADDR / T&A DIRECT DEPOSIT MANUAL RECEIPTING - Permits access to (STA9)
SSCWKR / WORKER TABLE (LOAD CODE) GROUP - Permits access to update load code tables (SWKR)

TYPE A and TYPE B AAA Offices ONLY: RTZ GET CARE

Add / Del / User Group / AAA Offices ONLY
Caretool / View/Update Caretool module for Options Counseling, OPI
Caretool Read Only / View but not update Caretool module
I&R / View/Update Information and Referral module
I&R Read Only / View but not updated Information and Referral module
Listing Maintenance / View/Update Resource listing maintenance module.
Agency Information / View/Update home agency information in ADRC
System Administrator / State Unit on Aging and Staff Only
Issue Manager / Report system issues
Reports / ☐ All ☐I&R Only ☐ Options Counseling Only
Options Counseling (OC) / ☐ OC ☐ OC MDSQ ☐ OC Enhancing Equity
OPI / Oregon Project Independence
OPI Pilot / OPI for ages 18-59
Digital Signature / Caretool Access Requirement
Medicaid Branches / For use in transmitting data to OACCESS
APD Oregon ACCESS security groups
Add / Del / User Group / Description of Branch Rights
595 XIX HDM update / Allows rights to print and preview the XIX HDM 595 and update HDM service units.
APS read only / Allows rights to read the Adult Protective Service (APS) information.
APS update / Allows rights to read and update the Adult Protective Service (APS) information.
CA/PSgeneral read + APS type / Allows read only rights to all CA/PS assessment type records including APS.
CA/PS general read / Allows read only rights to all CA/PS assessment type records except APS.
CAPS 2 HR exception T2 / Allows update rights to approve exception hours up to the local office to limit in hours act window.
CAPS 2 Asmt. Stat Admin. Act / Allows update rights to the assessment status for administrative reasons based on assessment status change rules.
CAPS 2 general read / Allows read rights to the assessment wizard, client details and service planning for all types except APS.
CAPS 2 general read + APS / Allows read rights to the assessment wizard, client details and service planning for all types including APS.
CAPS 2 general update / Allows read and update rights to the assessment wizard, client details and service planning for all types except APS.
CAPS 2 update APS type / Allows read and update rights to the assessment wizard, client details and service planning for CAPS APS type records.
CAPS 2 update OPI type / Allows read and update rights to the assessment wizard, client details and service planning for CAPS OPI type records. Should NOT permit to any user who has Mainframe rights to SSUHKOPI
CAPS 2 update PAS type / Allows read and update rights to the assessment wizard, client details and service planning for CAPS PAS type records.
CAPS 2 update
Title XIX type / Allows read and update rights to the assessment wizard, client details and service planning for CAPS Title XIX type records.
Case review web app. (Local)
General read / Allows read only rights to all Oregon ACCESS information including NAPIS/OAA information but not APS or CA/PS.
General update / Allows read and update to all Oregon ACCESS information except APS and CA/PS.
Medicaid general update / Allows update to most Oregon ACCESS information except APS, CA/PS and food benefits (SNAP).
NAPIS/OAA update / Allows rights to read/add/update NAPIS/OAA information (address; contact; nutrition risk/ADL; OAA service; case overview; OAA benefit).
Narrative update / Allows rights to update the narrative but no other information.
OAA client billing update / Allows rights to read and update OPI and OAA billing statements
OAA provider maintain / Allows rights to add and update OAA provider information, resource directory and NAPIS/OAA sites and providers.
OAA/OPI
general update / Allows rights to read and update OAA and OPI type records.Should NOT permit to any user who has Mainframe rights to SSUHKOPI
OPI financial update / Allows rights to add and update financial information.
Provider inquiry / Allows rights to read provider information but not the confidential
tax information.
Provider inquiry and financial / Allows rights to read provider information including confidential
tax information.
RAIN–NAPIS report preparers / Allows rights to read SPR preview and NAPIS reports. Allows rights to read and update enter management information.
RAIN–NAPIS report review / Allow rights to read SPR preview and NAPIS reports.
Screening update / Allows rights to update the screening functions but no other information.
Service update / Allows rights to update the service information, but are not authorized to update food benefits (SNAP), cash or Medicaid cases. Does not include APS or CA/PS.
/ XIX provider maintain / Allows rights to add and update provider information.SHOULD NOT permit to user who has Mainframe rights to SSUHKPAY or SSUHKVHR or SSUHKOPI.
Below are Statewide Rolls for Oregon ACCESS only
SW-CA/PS general read / Allows statewide read only rights to all CA/PS assessment records
except APS.
SW-CAPS 2 general read / Allows statewide read rights to the assessment wizard, client details and service planning for all types except APS.
SW-CAPS 2 update PAS type / Allows statewide read and update rights to the assessment wizard, client details and service planning for CAPS PAS type records.
SW-CAPS 2 update Title XIX / Allows statewide read and update rights to the assessment wizard, client details and service planning for CAPS Title XIX type records.
SW-general read / Allows statewide read only rights to all Oregon ACCESS information but not APS or CA/PS.
SW-NAPIS/OAA
service update / Allows statewide rights to read/add/update NAPIS/OAA information, (Address; contact; nutrition risk/ADL; OAA service; case overview; OAA benefit.)
Statewide narrative read-only / Allows statewide rights to read the narrative in all offices.
SW-narrative update / Allows statewide rights to update the narrative in all offices.
Signature All requests to be approved by user’s manager.
Manager: (print name) / Phone number:
() - / Ext.:
Manager signature: / Date:
//

E-mail . Or fax Attn: APD Chief Data Steward at 503-947-5357.

File: Original in local user file DHS 784 (11/16)

Page 1 of 11

User Name: RACF ID:

User name:RACF:
Additional restricted mainframe and OregonACCESS security groups
The following user groups are limited and need additional authorization. These rights cannot be added or deleted by the local sub-administrator. For rights to the following groups, the manager will need to fill out the first page and this section of this form and fax or e-mail both to: APD Chief Data Steward at 503-947-5357, or .
Add / Del / User Group Oregon ACCESS / Add / Del / User Group Oregon ACCESS
Help desk application experts / SW-help desk application expert
RAIN file upload / SW-Home Care Commission
RAIN provider batch / SW-maintain 595 rates
SW-APS read only / SW-Medicaid general update
SW-APS update / SW- OA only data provider update
SW-CA/PS general read + APS / SW- OAA provider maintain
SW-CAPS 2 HR exception T3 / SW- OAA/OPI general update
SW-CAPS 2 data integrity / SW- OMAP request
SW-CAPS 2 general read + APS / SW- provider inquiry
SW-CAPS 2 general update / SW- provider inquiry and financial
SW-CAPS 2 update APS type / SW- QA assessment update
SW-CAPS 2 update QA type / SW- RAIN administration
SW-case review web (PET) / SW- registry commission
SW-clear remote devices / SW- screening update
SW-delete case / SW- service update
SW-general update / SW- XIX provider maintain
Signature– All requests to be approved by user’s manager
Manager: (print name) / Phone number:
- - / Ext.:
Manager signature: / Date:
/ /
Additional instructions:

E-mail . Or fax Attn: APD Chief Data Steward at 503-947-5357.