User Request Forms

In order to gain access to the Virtual Gateway, an organization's Access Administrator must complete the appropriate User Request Form (URF) and Rider Form, if required by business service.

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.

Appeals Processing System (APS) User Request Form

Background Check System User Request Form

BSAS eLicensing Provider User Request Form

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

COGNOS User Request Form

Department of Mental Health Provider Portal (DMHPP) Form

DCF Management Report Form

DYS Agency User Request Form

DYS Provider User Request Form

EIM/ESM User Request Form

Eos (WIC) User Request Form

File Transfer Service HIPAA User Request Form

HCSIS User Request Form - Providers

i-FamilyNet User Request Form

MDS User Request Form

My Account Page (MAP) User Request Form

My Workspace User Request Form

Provider Data Management (PDM) User Request Form

School Nutrition Program (SNP) User Request Form

Turning 22 User Request Form

Women's Health Network (WHN) User Request Form