IRM-15: OASAS External User Access Request

Print clearly or type to avoid delays in processing the form.

Accurate logons are dependent upon the clear spelling of the user's name.

Enter the last name, first name, and middle initial (if applicable) of the individual seeking online access.

Enter a Security Keyword that is easily remembered (e.g., mother's maiden name).

Provide the individual's work email address.

Sign and date the form acknowledging agreement with the security statement and provide a contact phone number.

By signing, you also agree that you will neither share your access code with any other person nor share with any unauthorized person information obtained from these systems.

Misuse and abuse of information that is obtained from OASAS systems will result in a termination of access and may subject you to civil and/or criminal penalties.

In box 2, select and complete only one option, 2a. OR 2b.

Service Provider Name: Enter full provider name.

In OASAS Provider No., for OASAS certified and/or funded providers, enter the OASAS provider number, which is up to 5 digits in length.

LGU/County Name: Enter County name for LGU or county DMV users. Department of Motor Vehicles (DMV) employees who work at a county DMV office, as well as Probation, should complete LGU/County Name, e.g., DMV Albany County.

All other DMV employees enter DMV Central Office in Service Provider Name.

Enter the address (street, city, state, and zip code) of the requesting agency.

In box 4, for the System(s) to be Accessed, select all that apply.

Client Data System (CDS) enables providers of treatment services to report client demographic and service delivery data online.

Gambling enables OASAS certified providers of problem gambling treatment services to report demographic and service delivery data online.

Provider Directory System (PDS) enables OASAS certified and/or funded providers and associated LGU administrators to maintain their contact information and limited information regarding their provider and programs.

Continuing Care (CCARE) enables OASAS certified treatment providers to report on utilization of Continuing Care services on a per visit basis.

Impaired Driver System (IDS) enables providers of clinical services to impaired driving offenders and Impaired Driver Program (IDP) services to report client service delivery information online for motorists arrested for or convicted of impaired driving related offenses pursuant to section 1192 of the Vehicle and Traffic Law.

Impaired Driver Classroom (IDC) enables county DMV employees to enroll eligible motorists in New York State IDPs.

Training Catalog is a publicly accessible resource for trainings offered by OASAS and its Certified Education and Training Providers.

Perception of Care is a Survey System intended to support service providers in implementing effective client surveys as part of their Quality Improvement (QI) program.

In box 5, check only ONE OPTION for any system access.

In box 5, Options/Levels of Access, select the appropriate level of access for each system requested. Access level should be consistent with tasks to be performed.

Data Entry: Allows for online data entry and is inclusive of Inquiry access.

File Transfer: Allows for electronic batch/file transfer submission of data as well as online data entry and is inclusive of Inquiry access.

Inquiry: Allows read-only view of data.

Part B is to be completed and sent directly only by the External Access Approver (EAA) to OASAS.

Print last name, first name, and middle initial of External Access Approver (EAA).

Enter the Telephone No., Fax No. and work email address of the External Access Approver (EAA).

The External Access Approver authorizes the employee identified in Part A to obtain access to the system indicated in conjunction with his/her official duties.

The External Access Approver will contact OASAS immediately when the individual no longer requires such access.

Signature and Date: The representative authorized to approve data access for service provider (External Access Approver (EAA) is required to sign and date the form. By signing this form, the individual verifies that the appropriate access is being requested.

For CDS, PDS, Gambling, and CCare access, the OASAS provider's External Access Approver as identified in the PDS is required to sign Part B of this form.

This completed form must be sent directly to the NYS OASAS Provider Help Desk by the External Access Approver (EAA) signing the form or it will be returned without processing.

Please do not fax the instruction pages.

The Provider Help Desk will contact the individual directly to provide a confidential access code and instructions on establishing an individual password.

Please make sure when calling the OASAS Helpdesk for account access questions or for password reset, user must provide their security keyword in order to verify your identity.

If an incorrect login or password is used to access an OASAS system, the account will be disabled after five consecutive attempts.

Access rights will only be restored by contacting the Provider Help Desk.

If a user does not access an OASAS system during a consecutive 90-day period, the account will be disabled.

If a user does not access an OASAS system during a consecutive 400-day period, the account will be closed, and access rights terminated. Access rights will only be restored by resubmitting a new IRM-15 request.