Fillable Ps Form 1357-C - Customer Request For Web Access printable pdf download

Customer Request

for Web Access

A. Customer Identification

1. Name

2. Last 4-Digits of SSN

Maniokkanfj

3. Job Title

4. Telephone Number (Include area code)

m,m,m,m,m

5. Company Name

6. Email Address

7. Business Address

8. Corporate HQ Location (If different from your Business Address)

B. Cus tomer Computer Acces s Authorization

1.USER RESPONSIBILITY AGREEMENT STATEMENT: I am responsible for the Logon/Logoff, all actions pertaining to the use of my assigned logon ID, and

will not provide my logon ID to another person. Access to computer data or files not authorized to me is prohibited. My logon ID may be suspended indefinite-

ly if I violate security procedures. Misuse of a USPS computer system may result in disciplinary action and/or criminal prosecution. I understand that any de-

tected misuse of a computer system will be reported to the US Postal Inspection Service. The Postal Service reserves the right to monitor the network to

identify unauthorized attempts to upload or change information, or otherwise cause damage. Read the Privacy Act statement before signing. Note: The Priva-

cy Act statement MUST be on this form.

I certify that I have read and understand the foregoing and the Privacy Act statement below. Additional responsibilities can be found in Handbook AS 805,

ADP Security, and in the Administrative Support Manual.

Date

Requestor's

Signature

2. Application Name(s)

3.SITE ADMINISTRATOR RESPONSIBILITY STATEMENT: I authorize this person to have assess to USPS web application(s). I agree that the logon ID

will be used for authorized USPS work within the scope of my organization. I also agree that upon transfer or termination of user, I will advise the USPS

Computer Systems Security Office in writing as the disposition of the computer files and/or data and logon ID. I will periodically review the use of the as-

signed logon ID and files and/or data.

Additional responsibilities can be found in Handbook AS 805, ADP Security, and in the Administrative Support Manual.

Company Site Administrator's:

a. Name

b. Last 4-Digits of SSN

c. Date

d. r Signature

e. Telephone Number (Include area code)

C. USPS Computer Acces s Approval

a. Signature

b. Date

c. Telephone

1. USPS Functional System

Coordinator

a. Signature

b. Date

c. Telephone

2. USPS Login ID Administrator

D. Privacy Act Statement

The collection of this information is authorized by 39 USC 401 and Public Law 100-235, Computer Security Act of 1987. This informa-

tion will be used to assign computer logon IDs by which access to data and/or files on a computer system is limited to authorized per-

sons through the use of a computer security access control products. As a routine use, this information may be disclosed to a

congressional office at your request; to OPM for review of private relief legislation; to labor organizations as required by the NLRA;

where pertinent, in a legal proceeding to which the USPS is a party; to an appropriate law enforcement agency for investigative or

prosecutorial purposes; to a government agency where relevant to hiring, contracting, or licensing by the requesting agency; to an ex-

pert or consultant under contract with USPS to fulfill an agency function; to Federal Records Center for storage; to Merit Systems Pro-

tection Board or Office of Special Counsel for proceesins involving possible prohibited personnel practices. Completion of this form is

voluntary; however, if this information is not provided, you may not be granted a computer logon ID.

1357-C,

PS Form

October 2000

Ps Form 1357-C - Customer Request For Web Access

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