
O.gov OFFICE USE ONLY REQUEST FOR SECURITY ACCESS CODE SECURITY CODE ASSIGNED FORM 4678 (REV. 03-2010) INSTRUCTIONS: This form must be completed and approved before a Requester can obtain restricted information. Only Requesters who meet the criteria outlined in Section B are eligible to obtain restricted information and/or a security access code. REQUESTING: New Security Access Code (first time) Modify Information Recertification SECTION A. REQUESTER INFORMATION (THI.
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How to fill out the Form 4678 online
Filling out the Form 4678 online is a straightforward process that enables users to request a security access code for obtaining restricted information. This guide will provide clear and concise steps to complete the form efficiently and correctly.
Follow the steps to successfully complete the Form 4678 online.
- Click ‘Get Form’ button to access the form and open it in your preferred online editor.
- In Section A, complete the requester information by providing the name of the company or individual, and ensure to include any authorized personnel if needed. Fill in the required email address, telephone number, and fax number. Specify the physical street address, city, state, and ZIP code, along with any different mailing address if applicable.
- In Section A, describe the primary function of your business. Clearly explain how access to the requested records or personal information will be used to meet the requirements outlined.
- In Section B, authorize your request by certifying that it complies with the Federal Driver's Privacy Protection Act and Missouri law. Carefully review the applicable boxes relevant to your authorization type, such as being part of a government agency, law enforcement, or for business purposes.
- Indicate whether you or any partner or officer has ever had a Missouri Security Access Code in the section on previous access. If yes, provide the security access number or requester code.
- Read through the general security requirements carefully to ensure that you understand your responsibilities regarding the security and integrity of the information received.
- Review the statement of understanding and check the appropriate category for the requester type, such as individual, partnership, corporation, news agent, or government agent.
- Provide the necessary signatures from all authorized individuals and fill in notary information where required. Ensure that printed names and titles are accurately completed.
- Once you have filled out all sections of the form, save your changes, and then you can download, print, or share the completed form as needed.
Start filling out your Form 4678 online to obtain the necessary security access code.
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