Form IMS-01 at a glance
What it is: Form IMS-01 is the User ID and System Access Request Form (External) to request access to OPWDD systems.
Where and when to file: Submit completed form (that does NOT require section 5) or form related inquires to OPWDD IMS - External.Account.Provisioning@opwdd.ny.gov.
A filled-in Form IMS-01 example: a new CHOICES account request
How to fill out Form IMS-01, box by box
Section 1 - User Information
Do NOT handwrite ANY information. Please type ALL information requested and do NOT leave any box blank if requesting to use secure OPWDD application(s).
Provide your LEGAL first name, middle initial and last name. If you have no LEGAL middle name, type an “X”.
User must submit their form and confirm they do not legally have a middle name OR the middle name begins with an “X” within the body of the e-mail submission.
Section 2 - OPWDD Access Request
Do NOT handwrite ANY information.
Part 1 - Select ONE action from the 'Select an Action' dropdown menu.
Part 2 - Select ONE application from the 'Select an Application' dropdown menu.
Part 3 - If CHOICES is the selected application, select ONE role from the 'Select a Role' dropdown menu.
Part 4 - Choose One - "New User Account" or "Additional User Account". External Provisioning staff cannot provide the application needed nor a description of the applications.
Section 3 - Statement of Use
User should double check all information in Sections 1 and 2 if they did not complete those sections. User needs to read, sign and date.
By signing below, you confirm that you have read, agree, and understand the Section 3 Statement of Use, confirm you have provided your legal (first, middle initial, and last) name in Section 1 as well as confirm all information provided in Sections 1, 2 and 3 are correct.
If “Revoke” is chosen in Section 2, do NOT make any notation/marks/notes in Section 3. Do nothing in Section 3.
Section 4 - Executive Approval
Obtain the signature and printed name of the Executive Director or Authorized designee listed with OPWDD, along with the date.
Executive Director or Authorized Designee listed with OPWDD is required to sign, print and date for request of access or any modification/reactivation for a Section 1 user. Signature in Section 4 without a printed name will NOT be accepted.
Requests for Revoke or Close of a specific application is an exception and may be signed by the user who is currently employed with the provider agency, supervisor OR manager in lieu of the Executive Director, with their name and title printed under their signature.
When employee is no longer employed with provider agency, it is the responsibility of the agency to submit a Close request at that time (Sections 1, 2 and 4 ONLY). Failure to do so may result in a potential HIPAA Violation.
Section 5 - Secure NYS OPWDD Application Authorizer Approval (if required)
This section to be completed by a NYS employee ONLY and only if the Section 2 application chosen states that Section 5 is required.
If you do NOT see this previously mentioned note in Section 2, please do NOT alter this section in any way.
More rules for Form IMS-01
The form is REJECTED if Sections 1 or 2 have ANY handwritten, false or missing pertinent information to process the request.
Do NOT submit to the wrong unit or multiple units.
If your situation is different
Your request is for IRMA, DQIA or Fire Portal
Submit IR (IRMA) related requests or IRMA related inquiries to OPWDD IMU - Incident.Management@opwdd.ny.gov.
Submit QI (DQIA) related requests or inquiries to - DQI.Correspondence.Unit@opwdd.ny.gov.
Submit FA - Fire Portal requests or inquires to - Fire.Portal.Access@opwdd.ny.gov.
Common questions about Form IMS-01
Where do I file it?
Submit completed form (that does NOT require section 5) or form related inquires to OPWDD IMS - External.Account.Provisioning@opwdd.ny.gov.
When is this form not the right one?
Staff who have NOT officially started working at the agency should NOT request access to OPWDD systems.
Sources
[1] Form IMS-01 (Revised 2/2026), User ID and System Access Request Form (External), NYS Office for People With Developmental Disabilities (the Official source link on this page).
