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) 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
Department of Mental Health Provider Portal (DMHPP) Form
DYS Provider User Request Form
File Transfer Service HIPAA User Request Form
HCSIS User Request Form - Providers
My Account Page (MAP) User Request Form
My Workspace User Request Form
Provider Data Management (PDM) User Request Form