The state authorized official is the individual or individuals designated by the state to approve user account requests for other state users as noted in Section 4.3 of NYTD Technical Bulletin #4. Please provide the following information for the individual(s) who will serve as the state's authorized official(s). This form must be filled out completely for each registration or change in registration. The NYTD system administrator will verify all registration requests as needed. Confirmation of approved registrations, including initial account information for new users, will be sent to the email address provided by the user on this form.
* Denotes fields that are required.
If this is a request to add a new user, the user must sign and submit the "State User Security Compliance Statement" on the next page.