Security Access Request Forms - DPHHS Home 2026

1. Click ‘Get Form’ to open the Security Access Request Form in the editor.
2. Begin by entering the 'Name of Individual Requiring Deletion of Access' in the designated fields. Ensure you include both first and last names for clarity.
3. Fill in the 'Logon ID', 'Department', and 'Division/Bureau' fields accurately to identify the access that needs to be deleted.
4. Indicate whether the DPHHS position will be vacant longer than three months by selecting 'Yes' or 'No'.
5. Provide the address and county information, ensuring all details are correct for processing.
6. If applicable, specify if transferring to another DPHHS Division and name that division/bureau.
7. Complete the section on access to be deleted by choosing either 'All' or specifying particular access rights.
8. State the reason for termination of access clearly in the provided field.
9. Set the 'DATE / TIME DELETE TO BE EFFECTIVE' for when you want the access removal to take place.
10. Finally, ensure all signatures are completed: Employee, Supervisor, Data Owner, and Security Officer as required before submission.

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