Get End-user Account Request Form - San Bernardino County - Sbcounty

This guide provides a step-by-step approach to completing the End-User Account Request Form for San Bernardino County's Continuum of Care. Designed for new users, this comprehensive guide will assist you in submitting your request accurately.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form, allowing you to open it in your document management system.
2. Fill in today's date in the designated field, ensuring you accurately reflect when the request is submitted.
3. Select the purpose of the request by checking the appropriate box—New User, Delete User, Change User Information, or Other.
4. Enter the effective date for the request in the provided section.
5. Complete the Agency Information section by providing the agency name, telephone number (including extension), and agency address (street, city, state, and zip code).
6. Fill in the Employee (End-User) Information, which includes the employee's name, telephone number (including extension), title, email, and program.
7. Read and acknowledge the Authorization & Confidential Statement by signing and dating the form, ensuring compliance with confidentiality requirements.
8. Obtain the Executive Director’s signature and date as necessary for authorization.
9. Remember to sign and return the HMIS Policy and Procedures Agreement alongside this form to the Office of Homeless Services to receive your HMIS User ID and Password.
10. Once the form is completed, you can save the changes, download, print, or share it as needed.

Complete your request online using the guide above to ensure a smooth and accurate submission.