User Request Forms (URFs)

In order to gain access to the Virtual Gateway, an organization's Access Administrator must complete the appropriate User Request Form (URF) below.

Each URF is specific to the Virtual Gateway service an organization will use so please select the appropriate URF below. Please download a copy to your desktop, complete the form as per the instructions on the form, and email the complete form to the email address indicated on the form.

Please contact Virtual Gateway Customer Service with any questions at 1-800-421-0938.

Information for Access Administrators is also available for download.

Forms

• Children's Behavioral Health Initiative (CBHI) User Request Form 

• COGNOS User Request Form 

• Common Intake User Request Form 

• EIM/ESM User Request Form 

• Eos (WIC) User Request Form 

• File Transfer Service HIPAA User Request Form 

• HMIS User Request Form 

• i-FamilyNet User Request Form 

• IRIS User Request Form 
• Legislative Budget Tracking (LBT) User Request Form 

• Mass Commission for the Blind User Request Form 

• MDS User Request Form 

• Money Follows the Person (MFP) User Request Form 

• My Workspace User Request Form 

• Provider Data Management (PDM) User Request Form  file size 1MB

• User Account Deactivation Request Form 

Job Aids

• Deactivating Virtual Gateway Access   

 

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This information is provided by the Virtual Gateway within Health and Human Services.