State User Account Request

Instructions

This form must be filled out completely for each user account request. Once submitted the state authorized official will review and approve. The Authorized Official is the individual designated by the state to approve user account requests. The NYTD system administrator will verify all account requests as needed. Confirmation of approved user account requests, including initial account information for new users, will be sent to the email address in item 7 provided on this form.
Asterisks (*) in field names are used to denote required fields.

1. * Request Type: Indicate the purpose of the user's request.

2. * User Role:Indicate the role-based access of the user. "Default" users have view-only access to the state's NYTD data file transmissions. "Manager" users can view all state NYTD data file transmissions and can submit a data file on behalf of the state.

3. * State:

4. * Agency/Office: Indicate the user's agency/office (e.g. Children's Bureau):

5. * User First Name: * User Last Name:

6. * User Title:

7. * User Phone: * User Email:

If this is a new user account request, the user must acknowledge and submit the "State User Security Compliance Statement" on the next page.

NYTD: National Youth in Transition Database

State User Account Request Form