Form Dws-Wra 001 - Mis Reporting Request Form

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DWS-WRA 001
01/2012
 
MIS Reporting Request Form
 
 
Date _________________ 
 
User(s)/Requestor(s) ______________________________       E‐mail _________________________       Phone _______________ 
Select One
Division/Department   
 
 
Other: ____________________ Program 
_________________ 
(TANF, FS, WIA, UI, etc.) 
Q
O
(No Report), explain:  
       
UESTION 
NLY 
      New/Ongoing Report 
Ad‐hoc Report   
Existing Report Modification ‐ Report Name: ______________________ 
 
If New/Ongoing, what is the frequency of the report? 
      Weekly 
Monthly 
Quarterly 
Yearly   
Other ______________________________ 
Report Reason/Motivation: 
(Example: Legislative Request, Policy Change, etc.) 
 
 
 
 
            
Has this request been made previously?  
Yes 
No
NOTE: You may attach the original request to this e‐mail 
 
If yes, to whom and when?  
T
IME FRAME ‐ What date is the data needed?  __________ 
When will the report first be used? __________ 
 
Draft   
Final
REPORT CRITERIA 
(If this is a question only and no report is requested, enter N/A in the remaining required fields)
 
1. What data or changes would you like to see?
(Examples: 1) How many UI Claimants were in Salt Lake County within the past 3 months?  2) How many 
 
children are receiving CHIP in the state of Utah?  3) How many TANF recipients have a HS diploma/GED?)
  
 
 
 
 
 
 
 
2. Across what time period do you want the data to cover?
(Example: Most recent quarter, State Fiscal Year, Federal Fiscal Year, Calendar Year, etc.) 
 
 
 
3. How will the data be used? 
(Example: Program Evaluation, Trend Reports, Public Information, etc.) 
 
 
 
 
 
 
 
 
4. Who will be using the data?
(Example: Managers, Supervisors, Line Staff, Public, etc.)
 
5. How do you want the data displayed?
 (Examples: 1) Case, worker, program level; 2) Sorted by program type and ESA, programs per customer by month, etc.) 
 
 
 
**If you have a mock‐up of how you would like the report to be displayed, please send it as an attachment in the e‐mail 
request.** 
 
Please click the e-mail link (DWS_Data@utah.gov) to submit this request.
For users with the Free Acrobat
Reader application, e-mail the request to the above address using the "Attach to E-mail" option from the
File menu.
You will receive an e-mail response within 1 business day with the name of the Analyst who will
be working on your request.
 
 
Note: If this form is not filled out completely, the form may be returned to you for completion. 

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