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Security Access Request Forms

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 should be faxed to:
Network Security Unit: (406) 444-5924

Please do not return these forms to Payroll or Human Resources

Network Security Unit
Christi Mock, Computer Security Specialist
Technology Services Division
111 N Sanders, Room 204
Helena MT 59620

DPHHS Employee System/File Access Request Form
(revised 01/2013)

An OM-300A form must be completed and signed by employee and their supervisor for all new hires.

OM-300A (Word format)
OM-300A (PDF format)


Employee System File Access Request (Outlook Template)
May be used by supervisors for subsequent access requests for DPHHS employees only.

NON-DPHHS Employee System/File Access Request Form
(revised 01/2013)

An OM-300B form must be signed by all Non-DPHHS employees and their supervisor for initial access and any subsequent access requests.

OM-300B Word format
OM-300B PDF format

Access Delete Request Form
(revised 08/2012)

OM-300C (Word format)
OM-300C (PDF format)

Access Delete Request (Outlook Template)
May be used by supervisors for DPHHS and Non-DPHHS employees

Policies referred to in Security Access Request forms: