BPPS Authorization Form
SSN:  - - 
Name: 
(First, Mi, Last)
Dept: 
Fax to CSS Security (713) 500-4850
From:  Dept:  Fax# 
TPX ID:
(e.g.,2AMX)		 BPPS ID:
(e.g.,2AMX)
Bldg.Code/Rm: Phone: -
Required - Check the appropriate area(s) below:
New ID Transfer Change Access Delete ID 
Transaction Access
Mark the appropiate function access. 
PA Data Entry 
(Includes R01t, R51t, 
B03T, B07T, P03T and BPPS 
reference tables) 

Medical School Profile
       ___________________________
      Approval Signature
 
Additional Access 
Specify add, change, delete, or inquiry
Organization Access
Organization code is a seven digit code which identifies your department (e.g., 2/35/03/01). It can be found on table TN0T.
 
Corp
(01 or 02)		   Organization Code
(Area/Dept./Div./Sect.)		   PA Approval (Check Y or N)
    Y N 
    Y N 
    Y N 
    Y N 
    Y N 
    Y N 
Security Use Only
Training
Sec Admin.
RACFDUID
DMG(USRM13)
DRR
DNNM
S51T
S53T
S55T
ID Mailed/Complete

 
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 a 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

University of Texas - Houston Health Science Center. Client Support Services. UCT 1100. 500-4848

Printing & Faxing Instructions

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Last updated 8/19/1999