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 |