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.

User Request Forms (URFs)

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
• BSAS eLicensing Provider User Request Form
• Children's Behavioral Health Initiative (CBHI) User Request Form
• Cognos User Request Form (State Employee)
• Department of Mental Health Provider Portal (DMHPP) Form
• DCF Management Report Form
• DDS Background Check System User Request Form (Department of Developmental Services Programs Only)
• 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
• MassHealth Electronic Notice of Birth (MeNoB) User Request Form
• MDS User Request Form
• Money Follows the Person (MFP) User Request Form
• My Account Page (MAP) User Request Form
• School Nutrition Program (SNP) User Request Form
• Turning 22 User Request Form

Job Aids

Additional Resources

Deactivating Virtual Gateway Access

Virtual Gateway User Report Job Aid