Form 18 CTSU System Account Request Form

Attachment_1r_csarf
Attach_1dd_CSARF

OMB#0925-xxxx
OMB#0925-0624
Expiration Date:
Expiration
Date:xx/xx/xxxx
12/31/2013

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Send
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including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC
Bethesda,
MD
20892-7974,
ATTN:
PRA
(0925-0624).
Do
not
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the
completed
form
to
this
address.
Bethesda, MD 20892-7974, ATTN: PRA (0925-0624).
(0925-xxxx). Do not return the completed form to this address.

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OMB#0925-xxxx
OMB#0925-0624
Expiration Date:
xx/xx/xxxx
Expiration
Date:
12/31/2013

Attachment_1r_csarf
Attach_1dd_CSARF

CTSU System Account Request Form (CSARF)
With Completion Instructions

Instructions: The CSARF is for use by the CTSU and Cooperative Groups. Use the CSARF to request account access to systems used by
the CTSU except access to OC or RDC. Contact the CTSU Help Desk at 1-888-823-5923 or email them at CTSUContact@westat.com if
you have questions completing this form or need immediate access. Send the completed CSARF to the CTSU Help Desk. Allow 3 business
days to receive access.

Section 1 – User Information (All fields mandatory)

Specify/Comments

Requested for (First Last Name):
CTEP-IAM User Name:
CTEP Associate ID:
Date of Request (mm/dd/yyyy):
Email Address:
Phone:
Primary Affiliation1:
Organization1:
Organization Location – CTSU Staff Only1:
Primary Operations Group1:

Section 2 – System Access Information (Please review the CTSU System Account Request Form Completion Instructions when
completing the CSARF. Complete a separate line for each Service Type and System Access. Attach an additional form as necessary.)

System Access Requirement1

Service Type1

Service
Environment1

Privileges1

Study/Protocol
or Indicate ALL
for all
Studies/Protocols
(Required for
CDIMS/ CDTS/
FAXCOM)

Section 3 – Comments/Specify if Other selected above in Section 2:

1

Click in field to select from the list of values (LOV).

For Internal Use
Magic Incident #:

Completed By:

Completed Date (mm/dd/yyyy):

Approved By
(Name)
(To be completed
by the CTSU
Database Support
Associate)

Attachment_1r_csarf
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OMB#0925-xxxx
OMB#0925-0624
Expiration
Date:
xx/xx/xxxx
Expiration
Date:
12/31/2013

Section 1: User Information - All Fields Mandatory
a) Requested For: Enter the first and last name of the CTSU user you are requesting the account for.
b) CTEP-IAM User Name: Provide the User’s CTEP User Name (usually lastnamefirstinitial with no underscore). This is the same
user name used to access the CTSU website. For information on obtaining or locating your CTEP account information refer to:
https://eapps-ctep.nci.nih.gov/iam
c) CTEP Associate ID: Provide the User’s CTEP Associate ID. Users CTEP ID may be found in RSS. For information on obtaining
or locating your CTEP account information refer to https://eapps-ctep.nci.nih.gov/iam
d) Date of Request: Provide date the request is being submitted. Allow 3 Business days to receive access.
e) Email Address: Specify user’s email address.
f) Phone: Specify user’s phone number.
g) Primary Affiliation: Use the drop down list to select user’s primary affiliation. If other, specify name of primary affiliation in the
Specify/Comments column.
h) Organization: Use the drop down list to select user’s organization. If other, specify name of organization in the
Specify/Comments column.
i) Organization Location: Use the drop down list to select user’s location. Non-CTSU organizations, select N/A.
j) Primary Operations Group: Use the drop down list to select user’s primary operations group. If other, specify primary
operations group in the Specify/Comments column.
Section 2: System Access Information
a)

System Access Requirement: Use the drop down list to select each system the user requires access for. Use a separate line for
each system requested. If specify requested or other selected, specify system access requirement in Section 3 of the form. For
OC/RDC account requests contact the CTSU Help Desk. The CDIMS is the Clinical Data Image Management System for use by
Westat staff, and access to its components is based on project requirements:
1) CDIMS FAXCOM: Faxcom is a fax server configured to receive electronic images. Access is requested to reconcile CDIMS
reports. The user will receive access to all CTSU studies.
2) CDIMS Quillix - Consent queue: A queue used to review consent forms received in error. Documents with PII (Personally
Identifiable Information are removed from the CDIMS System. The user will receive access to all CTSU studies.
3) CDIMS Quillix - Doc_Delete queue: A queue for documents which will be removed from the CDIMS System (e.g., patient
consent). The user will receive access to all CTSU studies.
4) CDIMS Quillix - ExcepQ_Acorde: A queue where documents fall if there is a problem with the Stellent imaging database.
The user will receive access to all CTSU studies.
5) CDIMS Quillix - Manual Rel: A queue where documents reside if there is an invalid PID/Study/Event that is not acceptable in
WFM. The user will receive access to all studies for the specified location.
6) CDIMS Quillix - (Specify Loc - RV/Hou/Exp/Other): Users must select the appropriate location queue for processing
documents. If the study is managed by Rockville, specify RV; Houston, specify Hou; and, Durham, specify Exp (for the
expedited Phase I/Phase II studies). If other, specify the location where the study is being managed.
7) CDIMS Stellent Full Seat (Annotate Images): A browser used to view images in WFM and Oracle Clinical, and allows for the
annotation and redaction of images. The user will receive access to all CTSU studies.
8) CDIMS Stellent Image Browser (Westat DPC): This browser is limited to DPC due to licensing. Data Management staff
should request the CDIMS WISER Image Browser.
9) CDIMS WISER Image Browser (Westat non-DPC): The Westat Image Server (WISER) allows the user to view images in
WFM and Oracle Clinical. It does not allow for the annotation and redaction of images. The user will receive access to all
CTSU studies.
10) CDIMS Workflow Manager (WFM): Where documents are managed and processed to a final status according to study
requirements. The user will receive access to all CTSU studies.

b) Service Type: Use the drop down list to select the type of service required for the user’s account. Use a separate line for each
service type. If other, specify type of service in Section 3 of the form.
1) Delete Account – Deletion of a specified account from the database. This is the account issued for the System Access
Requirement and its associated Service Environment. Note: Changes to privileges should be submitted as a modification.
2) Delete All CTSU Accounts – Deletion of all of the user’s CTSU system accounts from the database.
3) Modify privileges – Modification to the type of permission to access an existing account.
4) New – New account to the database – first request for an account to access a system.
5) Other – If other, specify type of service in Section 3 of the form.
c)

Service Environment: Use the drop down list to select the type of service environment.
If other, specify type of service in Section 3 of form.

d Privileges: Use the drop down list to select type of privilege requested for user. Specific privileges may require department authorization.

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1)
2)
3)
4)
5)

e)

OMB#0925-xxxx
OMB#0925-0624
Expiration Date: xx/xx/xxxx
Expiration
Date: 12/31/2013

Admin – System modification rights
Read only – Unable to enter or modify data
Read/Write – Able to enter/modify data
Other – If other, specify type of privilege in Section 3 of the form.
Study/Protocol – This field is required for CDIMS, CDTS, and Faxcom. Specify the study/protocol to which the user should
be granted access. Enter one study per line. Attach additional forms as necessary. If access to all protocols is required, enter
‘all’ in this field.
a. For ‘CDIMS Quillix-(Specify Loc - RV/Hou/Exp/Other), indicate ‘all’ for each location since multiple studies are
accessible based on the location. Do not separately indicate each study.
b. For CDIMS components FAXCOM, Stellent and WFM, indicate ‘all’ since the user will receive access to all CTSU
studies when access is granted.

Approved By – The CTSU Database Support Associate (DSA) will verify approval using the CSARF Approval Matrix. To
expedite the process, the approver should email the completed CSARF to the Help Desk for processing. For Westat data
management and data processing staff, the approver is the clinical data manager or the data management coodinator for the project.

Section 3: Comments/Specify
If items in Section 2 are entered as ‘other’, specify responses in this section. Any requests for expedited accounts should be added to
this section. Other comments related to CTSU system accounts may be specified in this section.
Completion of Account Request
The CTSU System Account Request Form should be submitted to the CTSU Help Desk via email by the approver of the account. The
CTSU Help Desk will create a Magic Work Order assigned to the CTSU Database Support Associate (DSA), who will review the form
for completion. Once the form is reviewed and approval is verified, it will be submitted to the designated database administrator for set
up. The user will receive email notification that their account request was completed. Included in the email will be the user’s ID and
instructions for changing their password.
For Internal Use:
The CTSU DSA will enter the Magic work order #, name, and date upon completion of the request.