Security Access Request Forms
Some of the following forms are available in PDF format. If you do not have Adobe Acrobat Reader, click on the graphic to download a free version.
These forms are fillable online, but must be printed and signed by the person requesting access. DPHHS employees must also obtain their supervisor's signature. Forms must have a signature in order for the security unit to process an access request.
Completed forms may be sent to:
Colleen Llewellyn
DPHHS Systems Security Officer
Technology Services Division
1400 Broadway, Room B204
Helena MT 59620
FAX: (406) 444-5924
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DPHHS Employee System/File Access Request Form |
DPHHS Employee System/File Access DELETE Request |
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NON-DPHHS Employee System/ File Access Request Form |
NON-DPHHS Employee System/ File Access DELETE Request |
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Network Access Request Form
The Network Access Request form may be printed and filled out, or filled out online and printed, and mailed or deadheaded to the following address:
Network & Communications Bureau
1400 Broadway, Rm B204
Helena MT 59620
Network Access Form - OTD-004 (Word format) - You may fill out the Word form, save it, and then attach the saved file to an email addressed to: HHS Network Access (netaccess@mt.gov)
Network Access Request Form - OTD-004 (PDF format) (This form can be filled out and printed, but not emailed.)
If you have access to the State Outlook system, you may use the Network Access form in the Public Folders, which will allow you to open the form directly in Word, fill it out and email it from your Word program.
