Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start by selecting the appropriate category by checking one of the options: New Hire/Rehire/New User, Transfer/Job Change, Role Addition, Non Payroll Separation, or Remove Access. This selection indicates the reason for the authorization request.
3. Enter the effective date of the authorization request in the specified field. If available, include the current Edison Login ID.
4. Specify the user type by selecting from options: Central State Employee, Contractor, or External (Higher Ed, Loc Ed, Loc Gvt.). This information clarifies the user's role within the agency.
5. Fill in the Requesting Agency Information by providing the Agency Name, Agency Business Unit, Requester Name, Requester Phone Number, and Requester Email.
6. Complete the User Information section by entering the user's first name, middle initial, last name, organization, birth month, birth day, birth year, last four digits of the Social Security Number, User’s Department ID, Employee ID, and User’s Email Address.
7. In the Security Authorization Signatures section, ensure that both the agency and benefits administration sign and date the form. Print the names and titles of the signers.
8. Indicate the required access levels in the Data Access Levels section. This includes Agency Level, Department Level, Multiple Agencies, and Multiple Departments. Provide the corresponding department IDs as specified.
9. If needed, list the departments, divisions, and/or agencies for which the user will need access. You can include additional pages if necessary.
10. For Multiple Agency access, provide the reason for access in the designated field.
11. Once all sections of the form are correctly filled out, you can save your changes, download, print, or share the form as required. Finally, submit the completed form to ben.admin.syssup@tn.gov. Remember, the receipt date must be within 30 days of the signature date.

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