This form must be filled out completely by the federal staff person submitting the request. The NYTD system administrator will verify all account requests as needed. Confirmation of approved requests, including initial account information for new users, will be sent to the email address provided in this form. Please note: Federal users must have a Personal Identify Verification (PIV) card to access the system.
* Denotes fields that are required.
If this is a request to add a new user, the user must sign and submit the "Federal User Security Compliance Statement" on the next page.