BPPS Authorization Form

SSN: _______-____-__________ From: Dept: Fax#
Name: _____________________________ ___________________ _________________ _____________
(First, Mi, Last) TPX ID: ________________________

BPPSID: _________________
(e.g. 2AMX) (e.g. 2AMX)
Dept: _________________________ Bldg. Code/Rm.___________________

Phone:__-__-_____

Required – Check the appropriate area(s) below:

¡ New ID ¡ Transfer ¡ Change Access ¡ Delete ID

 

Transaction Access

Organization Access

Security Use Only
Mark the appropriate function access.

q PA Data Entry (Includes R01t, R5lt, B03T, B07T, P03T and BPPS reference tables)

q Additional Access (Specify add, change, delete, or inquiry)

 Organization code is a seven digit code which identifies your department (e.g., 2/35/03/01. It can be found on table TN0T. Training
____________________
Sec Admin.
____________________

Corp

(01 or 02)

Organizational Code

(Area/Dept./Div./Sect.)

PA Approval

(Check Y or N)

 q RACF q DUID

q DMG (USRM13)

q SM300

q SM680

q S51T

q S53T

q S55T
         

¡ Y ¡ N
         

¡ Y ¡ N
         

¡ Y ¡ N
         

¡ Y ¡ N
         

¡ Y ¡ N
         

¡ Y ¡ N

 ID Mailed/Complete
         

¡ Y ¡ N

  
Processor Access (For processor departments only)
Profile ________________________ PA Approval Code ________________________________
Additional Access _______________________________________________________________
_________________________ ______ _____________________ ______
Authorized Signature Date Authorized Signature Date
 
________________________________ ______________________________ _________
Manager Signature Print Name Date
 
All individuals are responsible for the management of information resources and are accountable for their actions relating to information resources security. Individuals using information resources are expected to know and comply with published university policies and procedures. By signing this contract, you agree to only use the userid/password for the purpose intended and not share or disclose a password. Failure on the part of any individual to comply may result in disciplinary action including suspension without pay or termination of employment or contract. A person may be subjected to civil or criminal legal sanctions when violation occurs. It is the responsibility of all personnel to report any suspected or confirmed violations of this policy to Client Support Services or appropriate management.
_________________________________________ __________________________ ____________
Employee Signature Print Name Date