Form Soc 883 - County Cmips Ii User Request Form Deactivate/reactivate User Page 2
Download a blank fillable Form Soc 883 - County Cmips Ii User Request Form Deactivate/reactivate User in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Soc 883 - County Cmips Ii User Request Form Deactivate/reactivate User with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3INSTRUCTIONS ON FILLING OUT COUNTY CMIPS II USER REQUEST FORM
Deactivate/Reactivate User
These instructions are to assist a requesting agency in completing the User Request form. Please be
sure to complete the form in its entirety. If you need assistance or have questions, please contact the
CDSS Adult Programs Systems Unit at (916) 551-1003.
USER INFORMATION
Action To Be Taken – Check appropriate box.
User’s Name – Check appropriate box and then enter first and last name of User.
Effective Date (MM/DD/YYYY) – Enter effective date. Month and day must have two digits
(e.g.01/05/2012) .
Authorizing Manager’s Name – Enter first and last name of Authorizing Manager.
Authorizing Manager’s Signature – Enter Authorizing Manager’s signature here.
Date – Enter date Authorizing Manager signed form.
PORTAL
Action To Be Taken – Check appropriate box.
Assign Access Dates (MM/DD/YYYY) : Leave blank if no access is to be given –
Enter date for each applicable area. If no specific end date is available, it is recommended that
“2099” be used in “End Date” fields.
Assign Portal Roles and Access Dates (MM/DD/YYYY) : Leave blank if no
access is to be given – Enter date for each applicable area. If no specific
end date is available, it is recommended that “2099” be used in “End Date” fields.
System Generated Password ( completed by Security Officer) – For Reactivation Only.
Upon completion of the reactivation, enter the system generated
password assigned to the user.
SOC 883 (8/13)
PAGE 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal