System Access Request Forms
NFC Security Access Forms are required to request access to NFC’s Insurance Processing Systems, or establish Insurance Security Officers. Use of a form reduces errors that can delay the provisioning or de-provisioning of critical access, which can affect users’ ability to complete their duties. For this reason, access requests MUST be submitted on an approved NFC or Agency-developed form.
Note, the Insurance Processing Request forms (AD-3100–C-Centralized Enrollment Clearinghouse Form (CLER), AD3100-CA-CLER Security Officer Authorization Form, AD3100-D-Direct Premium Remittance Form (DPRS), AD3100-DA-DPRS Security Officer Authorization Form, and AD3100-T-Tribal Insurance Processing Systems Access Request Form (TIPS)) are listed below.
|Form #||Description||Type, File Size|
|AD-3100-C||Centralized Enrollment Clearinghouse||PDF, 167KB|
|AD-3100-CA||CLER Security Officer Authorization||PDF, 81KB|
|AD-3100-D||Direct Premium Remittance||PDF, 185KB|
|AD3100-DA||DPRW Security Officer Designation Form||PDF, 83KB|
|AD-3100-T||TIPS Access Request Form||PDF, 223KB|