Form Isp 9-79a - User Identification/attribute Form Page 2

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I-CLEAR
**********System Access**********
User Identification/Attribute Form
Fax to: I-UCR Program – 217/524-8850
Data Warehouse
********** User Identification**********
I-Case (Check all that apply)
Name:_________________________________________ Date of Birth: ____/___/______
Mobile User
Agency Administrator
Badge/ID:________________ Title/Rank:_______________________________________
Organization Administrator
Supervisor
Investigator (Officers completing cases without supervisory authority)
E-mail: ___________________________________________Phone: ___/____-_________
Telecommunicator/Dispatcher
Civilian
**********Agency Information **********
Uniform Crime Reporting (UCR)
Agency Name: ______________________________________ORI: ____________________
**********User ID Disposition**********
Mailing Address:
____________________________________________
(IAC/ISP Administration Staff Use Only)
____________________________________________
I-Case Training Date: ____/___/_____ DWH Training Completed: Date: ____/___/______
LEADS Certification Expiration: ____/___/______
Supervisor Name: ________________________________ Phone: ____/_____-________
User ID: _____________________Entered by: __________________ Date: ____/___/______
Supervisor Signature: ________________________________Date: ____/___/_____
Temporary Password Entered by: _________________________
Date: ____/___/______
**********User Agreement **********
Email Notification to User Sent by: _________________________ Date: ____/___/______
I understand use of the Illinois State Police’s computer systems, all related equipment, software,
programs, data, manuals, and facilities is intended for and may only be used for the purpose of
accomplishing the official criminal justice business. Access to data and dissemination of data
Agency Hierarchy Assignment:
must be performed only in compliance with Illinois statutes and departmental policies (reference
ISP Directives Manual). I also understand that I am personally responsible for all usage under my
Division/Command: _______________________
user ID according to ISP Security policy. If I intentionally or carelessly disclose my user ID and
password, I understand that system usage is logged. If in an emergency I find it necessary to
Region: ______________________ District/Zone: ________________________
share my user ID and password with another person, I accept full responsibility for that person’s
usage of the system and at the earliest possible time, I will change or cause my password to be
Platoon: ______________________ Squad: ______________________________
changed.
User’s Signature: ___________________________________Date: ____/___/______
ISP 9-79A (3/11)

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