User Request Forms

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

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