Change Request Form for OA Login Accounts

Instructions to Applicant (this form is for use by government agencies only)

This Change Request Form is intended for an entire business unit of a government agency, not an individual user. It is intended to make administrative changes to an existing OA account. Complete this entire form.

Applicant Information

Today's Date (required):

Today

County/City/State Agency (required):
NOTE: Identify your agency name as it is written on the front page of the login account agreement attached to this change request.

Agency Contact Person

Agency Contact Name (required):

Agency Contact Position/Title (required):

Agency Contact Phone Number (required):

Agency Contact Email (required):

Director/Manager Authorizing Request (if different than Agency Contact)
Director/Manager Name:

Director/Manager Position/Title:

Director/Manager Phone Number:

Director/Manager Email:

OA Account Information

Account ID (required):
Please indicate the OA Account ID for which you are changing account access:

Please give us an update on the number of people in your agency that use this account:

Account Change

Remove Existing Account (required):

NoYes

Enter Account ID to remove:

Password

Request a password change (required):

NoYes

NOTE: You will be notified of your new password and the approximate date the password change will take effect. Please use your old password until you are notified of the effective change date.

Static IP Address

Remove Static IP Address (required):

NoYes

Enter a single, list, or range of Static IP Addresses to remove:

Add Static IP Address (required):

NoYes

Enter a single, list, or range of Static IP Addresses to add:
NOTE: A range should only be provided for the business unit needing access and not the entire county/agency.

Change Request Form for OA Login Accounts

Instructions to Applicant (this form is for use by government agencies only)

Applicant Information

Agency Contact Person

Director/Manager Authorizing Request (if different than Agency Contact)

OA Account Information

Account Change

Password

Static IP Address