Form FNS-674 FNS User Access Request Form

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OMB APPROVED NO. 0584-0532
Expiration Date: XX/XX/XXXX
U.S. Department of Agriculture - Food, Nutrition and Consumer Services

User Access Request Form

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0532. The time required to complete this information collection
is estimated to average 1 0 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center
Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584-0532). Do not return the completed form to this address.

User Information

First Name

1. Last Name

Middle Name

6. Type of User (select one) 7. Telephone

8. Contract Expiration Date (if applicable) 9. Temporary Employee Expiration Date (if applicable)
12. Department

11. Division

13. Office (select one)

3. Date of Request

5. USDA E-Auth User ID, (if applicable)

4. Work Email

10. Company

2. Title

Suite #

Office Street Address
State

City

ZIP Code
15. Type of Access / Role

14. System Name

16. Action Requested

18. Program and Form (applicable for FPRS)

17. System Login User ID (current users)

19. State/Locality Codes
20. Comments, Special Instructions and/or Justification (if "Other" is selected in fields 6, 13, or 14). (attach separate sheet if more space is
needed)

Privacy Act Statement
Authority:
The authority in collecting this information is Public Law 107-347.
Purpose:
This information is collected to ensure accounts are created with the correct information and access permissions for individuals.
Routine Use: The information will be used to create accounts and grant access permissions.
Disclosure: Furnishing information on this form is voluntary. Failure to provide correct information will result in denial of account or access
permissions.
21. User Acknowledgement (Users requesting system access must read, sign and date prior to submitting this form)
I have read and understand the Privacy Act Statement above and the FNCS Rules of Behavior (see page 2 for complete verbiage)
Decisions in personnel matters involving disciplinary action will be based on the assumption that I am familiar with the security requirements presented in
these rules and I am aware of my obligation to abide by them.
I understand that systems require security to protect user and system files from unauthorized access.
I have completed this form to the best of my abilities.

User Signature

Print Name

Date

Approvals
22. a. Supervisor / COR
Print Name

Phone Number

Approve

Date

FORM FNS-674 (03/18) Previous Editions Obsolete

Deny

Signature

SBU

Electronic Form Version Designed in Adobe 10.0 Version
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Approvals (continued)
b. System - Authorizing Official (FNCS)
Print Name

Approve

Phone Number

Date

Deny

Signature

c. Information Security Office (FNCS)
Approve

Print Name

Phone Number

Date

Deny

Signature

d. State Computer Security Officer (if applicable)
Print Name

Phone Number

Approve

Date

Deny

Signature

To be Completed by IT Customer Support (FNCS)
23. Has the Security and Privacy Training
been completed?
YES
NO

24. Date Received

25. Person Receiving Request

26. Date Completed

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Rules of Behavior (ROB) - FNCS General User
User ID and password
The User ID and password being issued to you must not be shared with or given to anyone else. FNCS Users who share their User ID or
password will be in violation of the Computer Fraud and Abuse Act of 1986. If you forget your password or believe your password has
been compromised, contact the ISO immediately. To have your account reset, contact IT Customer Support (1-888-OIT-4FNS) or open a
ticket through the Help Desk ticketing system.
Monitoring and Auditing of FNCS Information Resources
At anytime, FNCS/USDA may monitor and/or audit user activity and/or network traffic. In addition, USDA may access your system and
disclose information obtained through audits to third parties, including law enforcement authorities. Acceptance of the warning banner prior
to logging onto the FNCS network is your acknowledgment of the FNCS/USDA monitoring/auditing.
Violations
Violations of information system security guidelines and procedures may lead to disciplinary action up to and including termination of
employment.
Manager/Supervisor Responsibilities
All persons in a management role at FNCS must be aware of and knowledgeable in information system security practices. Managers are
responsible for enforcing these practices within their areas and will be held accountable for ensuring that users are aware of and
acknowledge their responsibilities. FNCS Management is also responsible for ensuring that all FNCS Users, i.e. Employees, Contract
Personnel and Official Visitors attend mandatory computer security training.
FNCS User Responsibilities
FNCS User's access to information system resources indicates a level of trust between the User, FNCS Management and ISO. Therefore,
FNCS Users are held accountable for the following:
Ensure the ethical use of FNCS information resources in accordance with FNCS guidelines and procedures.
Utilize all security measures that are in place to protect the confidentiality, integrity and availability of information and systems.
Refrain from using FNCS information resources for inappropriate activities.
Adhere to all licenses, copyright laws, contracts, and other restricted or proprietary information.
Always safeguard User IDs, passwords, and smartcards.
Protect FNCS information resources when working remotely by ensuring the latest patches and antivirus software are loaded on your
Government Furnished equipment (GFE).
Limited personal use of the Internet is allowed as long it does not interfere with official business or reflect adversely on FNCS Information
Systems.
Access only those information systems, networks, data, control information, and software that you are authorized to use.
Know who your Information System Security Officers (ISSOs) are and how to contact them.
Determine the sensitivity of the information and programs on your computing resources (e.g. non-sensitive, sensitive but unclassified).
Avoid the introduction of harmful files/data that may contain spy-ware, viruses, etc. into any computing resource.
Please refer to the Guidance on Acceptable Use of FNCS Information System in the 702 handbook for additional acceptable uses of the
system.
Please refer to the 702 handbook for guidance on social media and networking site use on FNS Government Furnished Equipment (GFE).
If you have any questions on FNCS Information Systems Security, please contact IT customer support (1-888-OIT-4FNS) or send an email
to the Security Mailbox at SecurityOfficers.Mailbox@fns.usda.gov.

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Form Instructions
1. LAST, FIRST, MIDDLE NAME - Enter the last name, first name and middle name (if applicable) of the person requesting FNCS computer
system access. If middle name does not exist, enter n/a.
2. TITLE - Enter current Title.
3. DATE OF REQUEST - Select from the calendar, the date you are requesting access to an FNCS system.
4. WORK EMAIL - Enter the FNCS email address, if known.
5. USDA E-AUTH USER ID - Enter your official e-Authentication ID, (existing users).
To obtain an E-Auth User ID go to the site map at https://www.eauth.usda.gov/MainPAges/eauthsitemap.aspx and click on "Create an
Account"
6. TYPE OF USER - Select your user type from the drop-down menu; Federal, State, Contractor, JP Morgan or Other. “If “Other” was selected in
this field, please provide an explanation in Field 22 of what “Other” means as well as the justification for the selection.”
7. TELEPHONE- Enter telephone.
8. CONTRACT EXPIRATION DATE - If you are a Contractor, enter your Contractor Expiration Date. Please contact your COTR for this date.
9. TEMPORARY EMPLOYEE EXPIRATION DATE - If you are a Temporary Employee (Intern), enter your Expiration Date. Please contact your
supervisor for this date.
10. COMPANY - Enter your company/agency affiliation.
11. DIVISION - Enter your division affiliation.
12. DEPARTMENT - Enter your department affiliation.
13. OFFICE - Select your office affiliation from the drop-down menu. Enter the street number, street name, suite number, city, state and zip code
of the facility where the requesting user will be working. “If “Other” was selected in this field, please provide an explanation in Field 22 of what
“Other” means as well as the justification for the selection.”
14. SYSTEM NAME - Enter the system that you are requesting to access. “If “Other” was selected in this field, please provide an explanation in
Field 22 of what “Other” means as well as the justification for the selection.”
15. TYPE OF ACCESS / ROLE - For the system, enter the type of access or role requested. Access and role types are system specific. Please
check with the System Owner to determine the appropriate access or role type.
16. ACTION REQUESTED - Enter the type of access requested for this system, if you are not sure, please contact the system owner for the
appropriate action.
17. SYSTEM LOGIN USER ID - If an existing account, enter in your current login ID.
18. PROGRAM AND FORM - This field is needed for FPRS access only. Enter the form that the user has requested to access.
19. STATE/LOCALITY CODES - Enter the state/locality codes that are needed for system access. State/Locality codes are FNCS organization
codes that specific systems may require. If required, these codes will determine the information that you can access within the FNCS system.
If you do not know your state/locality code, please contact the System Owner for the code.
20. COMMENTS, SPECIAL INSTRUCTIONS - Enter any comments or special instructions that are needed for the completion of this request for
system access.
21. USER ACKNOWLEDGEMENT - Read the Privacy Act Statement and the FNCS Rules of Behavior (ROB), sign and date the user
acknowledgement statement. This must be completed prior to submitting this form to your supervisor.
22. APPROVALS - Prior to the user submitting the User Access Request form, it must be approved by the following: the user's Supervisor, the
Authorizing Official for the system, the Information Security Office and the State Computer Security Officer, if applicable.
23. SECURITY and PRIVACY TRAINING COMPLETE - This section is for FNCS IT Customer Support and Information Security Office Staff use
only.
24. DATE RECEIVED - This section is for FNCS IT Customer Support and Information Security Office Staff use only.
25. PERSON RECEIVING REQUEST - This section is for FNCS IT Customer Support and Information Security Office Staff use only.
26. DATE COMPLETED - This section is for FNCS IT Customer Support and Information Security Office Staff use only.

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