6-Attachment J- 3rd Party Access RACF-1 (6.2025).pdf

Attachment J: DWS 3RD PARTY ACCESS REQUEST FORM State of Utah

Department of Workforce Services

COMPLETE the User Information, sign, and return to the DWS Contract Owner:

INFORMATION ACCESS (Completed by DWS and DTS)

Email of Contract Owner:

3rd Party Agency Contract or Agreement Number:

Contract Dates: Start Date: End Date:

USER INFORMATION (Complete All Fields)

Agency Name:

User First Name: User Last Name:

Work Phone: Work Email:

Access Effective Dates: Start Date: End Date:

Is an RSA Token Required for Access? Yes. No.

If a token is required, do you have an RSA Token?

Yes: What is the token number (9-digit number on back)?

No: I need a Token mailed to me:

Mailing address to where you’d like the token sent (tokens cannot be sent to a residential address or PO Box):

REQUESTED ACCESS

Application and Role (Please indicate the application to which access is needed and the needed role within the application)

Role: Role:

AUDITOR

AWARE

CONTENT NAVIGATOR

EREP

Care About Childcare

Other Special Access:

Special Instructions/Comments:

ESHARE

UI Benefits Website

TEVS

UWORKS

Refugee Partner Portal

DWS-ADM RACF-1

Rev. 06/2025

Division Name (if applicable):

State of Utah Department of Workforce Services

User and their Supervisor must read the following Security Policy and sign the Acknowledgment.

DWS COMPUTER SECURITY POLICY

Computer system resources and information of the Department of Workforce Services (DWS) are information technology assets of the State of Utah and must be protected. This includes protection from unauthorized disclosure, modification, or destruction, whether accidental or intentional.

Access to DWS computer systems is given on a need-to-know basis only. This is authorized by certified owners of the specific system. Any unauthorized or improper use of the system, or providing access to others by disclosing access codes, passwords, or leaving active workstations unattended, may result in loss of access and prosecution under state and federal statutes.

Users granted access to DWS computer systems may access the information only for legitimate business purposes and must guard against improper use of disclosure of this information. Any information accessed through a DWS computer system is confidential. Supervisors must notify the Contract Owner immediately when a User's access to DWS computer systems must be removed because of termination, transfer or other reasons.

Users are not allowed to access their own information or the information of family members or close acquaintances.

Information systems are monitored to detect inappropriate access and protect customer information. Access, including queries, are logged and stored. 90 days of user inactivity will result in the termination of user’s access (this is 60 days for eREP and 45 days for UWORKS).

Users must immediately report any suspicion or knowledge of any inappropriate access, compilation, distribution, misuse or disclosure of confidential information. Failure to do so may lead to User's loss of access, and civil and criminal sanctions, resulting from prosecution under state and federal statutes.

User acknowledges the following:

• I understand there are confidentiality laws, regulations and policies that govern DWS data.

• I will only use the information for purposes specifically authorized in the contract or agreement between my agency and

DWS.

• I understand that I am not allowed to access my information or the information of family members or close acquaintances.

• I understand that I am not allowed to access the system when outside of the United States.

• I agree to comply with program confidentiality requirements specified in that contract or agreement.

• I agree to return the RSA Token assigned to me once my current need for access has ended.

• I understand my failure to safeguard confidential data may result in penalties, including fines, costs of prosecution, and imprisonment.

User has read, understands, and agrees to the DWS Computer Security Policy:

USER’S NAME (print):

USER’S SIGNATURE: /s/ DATE:

Supervisor acknowledges that User has been trained in DWS confidentiality, privacy and non-disclosure policies:

SUPERVISOR NAME (print): EMAIL:

SUPERVISOR SIGNATURE: /s/ DATE:

DWS-ADM RACF-1

Rev. 06/2025