
Texas Department of Human Services FAX TO: Form 4743 04-2002 REQUEST FOR APPLICATIONS & SYSTEM ACCESS Management Information Services State Office C-732, FAX (512) 438-5288 Identifier FOR SECURITY.
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How to fill out the Hhsc Form 4743 online
This guide provides a comprehensive overview of how to fill out the Hhsc Form 4743 online. Designed for individuals seeking access to system applications or making changes to user information, this step-by-step guide will help you successfully navigate the form.
Follow the steps to complete your Hhsc Form 4743 online.
- Press the ‘Get Form’ button to obtain the Hhsc Form 4743 and open it in your preferred editing tool.
- Complete the 'Identifier' section by entering the required identification details for security purposes, ensuring accuracy.
- Fill in the 'FROM' section with your name, city, and region, as well as your mailing code.
- Indicate the 'Type of USER Change' you are requesting by selecting 'Add New', 'Delete', or 'Modify'.
- Provide the employee details, including their name as it appears in the AASS, effective, hire, or termination date, employee number, and phone number with the area code.
- Enter the Social Security number and email address for the employee.
- Select the employee title or contractor designation from the provided options.
- Indicate the relevant access types, such as 'Production' or 'Development' for various systems and applications listed.
- Complete the 'DBA USE ONLY' section where applicable, including login and effective dates.
- Ensure that the print and signature fields for the supervisor and Regional Automation Director are filled out correctly, including the date.
- Review the entire form for completeness and accuracy before finalizing your submission.
- Once you have completed the form, you can save your changes, download, print, or share the form as needed.
Begin filling out your Hhsc Form 4743 online today.
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