Form 17 System Access Request Form

Attachment_A17_csarf

OMB# 0925-0753
Expiration Date 07/31/2021

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OMB#0925-0753
Expiration Date: 07/31/2021

Attachment_A17_csarf

CTSU System Access Request Form (CSARF)
Instructions: Use this form to request access to CTSU Enterprise Systems for network administrative
staff, NCI staff, and NCI contracting staff outside of Westat and the Coalition. The network authorizer
should submit the form via e-mail to the CTSU Help Desk at ctsucontact@westat.com. A list of network
authorizers is given on the last page of the form. All persons requiring access must have an active CTEP
ID. Please allow three business days for processing.
User Profile
Date of Request
Type of Request
User Name
User CTEP ID
E-mail
CTEP User Name
Organizational Affiliation/Primary
Groups
Comment (complete if affiliation
request additional information)

Click here to enter a date.
Choose an item.

Choose an item.

RSS User Account
Use this block for RSS account requests. Please indicate any special requests outside of the standard
user profiles in the special requests/notes row.
Access Profile
Screen Access/Rules
Request (add,
remove)
Staff Profile
Read access to institution and person roster
Choose an item.
screens; Read access to site registration,
protocol, and IRB screen (excluding CAP
screen, req. library, and packets DMS
browser); Read access to the PEC and PEC
browser; Ability to run reports under the
General reports tab & ability to view user
documents.
Membership Profile
Read/Write access to institution and person
Choose an item.
roster screens; Read access to site
registration, protocol, and IRB screen
(excluding CAP screen, req. library, and
packets DMS browser); Read access to the
PEC and PEC browser; Ability to run reports
under the General reports tab & ability to
view user documents.

July 2018

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Attachment_A17_csarf

OMB#0925-0753
Expiration Date: 07/31/2021

CTSU System Access Request Form (CSARF)
RSS User Account
Use this block for RSS account requests. Please indicate any special requests outside of the standard
user profiles in the special requests/notes row.
Access Profile
Screen Access/Rules
Request (add,
remove)
Regulatory Profile
Read access to institution and person roster
Choose an item.
screens; Read/write access to protocol
screen; Read access to site registration and
IRB screen (excluding CAP screen, req. library,
and packets DMS browser); Read access to
the PEC and PEC browser; Ability to run
reports under the General reports tab &
ability to view user documents.
Special Requests/Notes
CTSU Working Groups/SharePoint Access
Use this block when requesting additions and removals from working group lists or SharePoint. Leave
the request block blank if access is not required.
Working Group or SharePoint
Comment
Request (add,
remove)
Choose an item.
Choose an item.
Choose an item.
Choose an item.
CTSU Operations Roles
Use this block to request a CTSU Operations role for network or NCI staff. Indicate add or remove
under the request column for the desired role, leave the request column blank if the role does not
apply. CTSU uses roles for contact purposes, but roles are not required.
Role
Definition/Rule
System Access
Request (add,
remove)
Admin-Staff
Limited to support project staff (i.e.
Website
Choose an
IROC and BPC) and other contractors
item.
per NCI authorization.
Audit Associate
Staff person who works on audits.
N/A
Choose an
item.
Center Group Staff
Read only view to organization’s
CENTER View
Choose an
data in CENTER
item.
CIRB QC
Role to allow CIRB staff to QC CIRB
CTSU Web UAT
Choose an
document posting
item.
Limited to CIRB staff
July 2018

Page 3 of 7

Attachment_A17_csarf

OMB#0925-0753
Expiration Date: 07/31/2021

CTSU System Access Request Form (CSARF)
CTSU Operations Roles
Use this block to request a CTSU Operations role for network or NCI staff. Indicate add or remove
under the request column for the desired role, leave the request column blank if the role does not
apply. CTSU uses roles for contact purposes, but roles are not required.
Role
Definition/Rule
System Access
Request (add,
remove)
CM_Review
NCTN staff who review documents
Source Document Choose an
posted to central monitoring
Portal
item.
component of the source document
portal.
CM_Triage
NCTN staff who triage documents
Source Document Choose an
posted to the central monitoring
Portal
item.
component of the source document
portal.
CTRO Contact
Point of contact for questions
CTRP reporting
Choose an
related to NCI.gov and CT.Gov
item.
inquiries and default contact if site
level contact is not available.
Clinical Document
CTSU staff who have access to
Source Document Choose an
Access
review documents posted to the
Portal
item.
source document portal.
Limited to CTSU staff
Contract Specialist
Individual at the organization
N/A
Choose an
responsible for discussing contracts.
item.
Data Management
Organization or CTSU staff person
N/A
Choose an
Associate
responsible for some aspect of data
item.
management.
DTL Setup
Individual at the organization
N/A
Choose an
responsible for Lead Protocol
item.
Organization DTL setup.
Financial Associate
Organization or CTSU staff person
N/A
Choose an
who works with financial aspects of
item.
the project.
Group Administrator
NCTN or other organization
N/A
Choose an
administrator
item.
NCTN Group Chair
NCTN Group Chair
N/A
Choose an
item.
Help Desk Associate
Staff person working on customer
N/A
Choose an
service aspects of a project.
item.
IT Associate
Organization or CTSU IT staff
N/A
Choose an
item.
July 2018

Page 4 of 7

OMB#0925-0753
Expiration Date: 07/31/2021

Attachment_A17_csarf

CTSU System Access Request Form (CSARF)
CTSU Operations Roles
Use this block to request a CTSU Operations role for network or NCI staff. Indicate add or remove
under the request column for the desired role, leave the request column blank if the role does not
apply. CTSU uses roles for contact purposes, but roles are not required.
Role
Definition/Rule
System Access
Request (add,
remove)
LAO Administrator
LAO primary contact
N/A
Choose an
item.
LAPS Admin
LAPS primary contact
Funding Reports
Choose an
item.
LAPS Report
Access to funding reports
Funding Reports
Choose an
item.
Membership
Organization or CTSU staff person
N/A
Choose an
Coordinator
responsible for maintaining rosters
item.
NCI_Staff
Individuals with NCI requiring
Expanded access
Choose an
expanded access.
to protocol, DQP, item.
Limited to NCI staff
OPEN and CM
data
OPEN Administrator
Limited to Roster Owner staff and
N/A
Choose an
granted in RSS UAT (test).
item.
Education and
Organization or CTSU staff person
N/A
Choose an
Promotion
who works on educational or
item.
promotional tasks
Project Administrator
Organization or CTSU administrative N/A
Choose an
staff
item.
Project Manager

Primary project lead

N/A

Protocol Coordinator

Staff person who develops protocol
documentation.
Organization or CTSU staff
responsible for quality assurance
Identifies individual at the
organization who can authorize
access to RSS for others at their
organization.
CTSU assigned role to identify RSS
users
Organization or CTSU staff person
with registration privileges

N/A

QA Associate
RSS Authorizer

RSS User
Registrar

July 2018

N/A
N/A

N/A
OPEN

Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.
Choose an
item.

Page 5 of 7

Attachment_A17_csarf

OMB#0925-0753
Expiration Date: 07/31/2021

CTSU System Access Request Form (CSARF)
CTSU Operations Roles
Use this block to request a CTSU Operations role for network or NCI staff. Indicate add or remove
under the request column for the desired role, leave the request column blank if the role does not
apply. CTSU uses roles for contact purposes, but roles are not required.
Role
Definition/Rule
System Access
Request (add,
remove)
Regulatory Associate
Organization or CTSU staff
N/A
Choose an
responsible for regulatory processing
item.
Rave Primary URL
Primary point of contact at the
N/A
Choose an
Owner
organization for the Rave URL
item.
Rave Secondary URL
Secondary point of contact at the
N/A
Choose an
Owner
organization for the Rave URL
item.
Site Code Update
Common listserv for site code
N/A
Choose an
Listserv
updates
item.
Staff
General term
N/A
Choose an
item.
Statistician
Organization or CTSU Statistician
N/A
Choose an
item.
System Administrator
Staff responsible for system
N/A
Choose an
maintenance and performance
item.
TRIAD Administrator
Limited to TRIAD QC Center staff
TRIAD
Choose an
item.
TRIAD QC User
Limited to TRIAD QC Center staff
TRIAD
Choose an
item.
TRIAD Review
Limited to TRIAD QC Center staff
TRIAD
Choose an
item.
Transfer Coordinator
Person with responsibility to manage N/A
Choose an
transfers
item.
Westat Staff
Reserved for Westat staff
N/A
Choose an
item.
List of Authorizers as of 7/16/2018
Organization
Authorizer
ABTC
Joy Fisher
Alliance
Trini Ajazi
Alliance
Marcia Kelly
CIRB
Brian Campbell
COG
Michele Wilkins-Sanchez
CTSU (all others)
Martha Hering

July 2018

E-mail
jfisher@jhmi.edu
tajazi@uchicago.edu
marciak@uchicago.edu
bcampbell@emmes.com
mwilkins@childrensoncologygroup.org
marthahering@westat.com

Page 6 of 7

Attachment_A17_csarf

OMB#0925-0753
Expiration Date: 07/31/2021

CTSU System Access Request Form (CSARF)
List of Authorizers as of 7/16/2018
Organization
Authorizer
CTSU (all others)
Ravi Rajaram
ECOG-ACRIN
Juanita Andrews
NCIC-CTG
Corey Willman
NCIC-CTG
Lam Pho
NRG
Katie Campbell
NRG
Christine Gosik
NRG
Sharon Hartson Stine
NRG
Nancy Soto
PBTC
Prasanna Velamuru
SWOG
Connie Barnes
IROC-Houston
Jessica Lowenstein
IROC-RI
Fran Laurie, Esther Akanbi,
Matthew Iandoli
IROC-Philly (RT)
Denise Manfredi and Tammy
McGlade
IROC-Philly (IMG)
James Gimpel
IROC-Ohio
Timothy Sbory
Wake
Karen Carver
URCC
Jacque Lindke

E-mail
ravirajaram@westat.com
Andrews.juantia@jimmy.harvard.edu
cwillman@ctg.queensu.ca
lpho@ctg.queensu.ca
kcampbell@gog.org
cgosik@nsabp.org
shartson@acr.org
nsoto@acr.org
prasanna.velamuru@stjude.org
cbarnes@swog.org
jlowenst@mdanderson.org
flaurie@QARC.org, EAkanbi@qarc.org,
miandoli@qarc.org
dmanfredi@acr.org,
tmcglade@acr.org
jgimpel@acr.org
sbory@wcibmi.org
kcraver@wakehealth.edu
jacque_lindke@urmc.rochester.edu

Internal Use Only
Date Received
Verify Authorizer
Date Processed

July 2018

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