Form 17 System Access Request form

Attach_A17_csarf

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

Attach_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 [email protected]. A list of network
authorizer 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.
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

June 2016

Page 1 of 5

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)
(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 Role
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 NCI and support staff to
Website
Choose an
allow access to all protocols on the
item.
CTSU Website.
Audit Associate
Staff person who works on audits.
N/A
Choose an
item.
Center Group Staff
Read only view to organization’s data CENTER View
Choose an
in CENTER
item.
Contract Specialist
Staff person working with contracts
N/A
Choose an
for the organization.
item.
CIRB QC
Role to allow CIRB staff to QC CIRB
CTSU Web UAT
Choose an
document posting
item.
Limited to CIRB staff
CTEP Staff
Designates CTEP staff
N/A
Choose an
Limited to CTEP staff
item.

June 2016

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CTSU System Access Request Form (CSARF)
CTSU Operations Role
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)
CTEP/TRI Web
Limited to CTEP staff
Web Reporting
Choose an
Reporting
item.
CTRO Contact
Point of contact for questions related CTRP reporting
Choose an
to NCI.gov and CT.Gov inquiries and
item.
default contact if site level contact is
not available.
Data Management
Organization or CTSU staff person
N/A
Choose an
Associate
responsible for some aspect of data
item.
management.
Financial Associate
Organization or CTSU staff person
N/A
Choose an
who works with financial aspects of
item.
the project.
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.
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.
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.

June 2016

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CTSU System Access Request Form (CSARF)
CTSU Operations Role
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)
Project Manager
Primary project lead
N/A
Choose an
item.
Protocol Coordinator
Staff person who develops protocol
N/A
Choose an
documentation.
item.
QA Associate
Organization or CTSU staff responsible N/A
Choose an
for quality assurance
item.
Registrar
Organization or CTSU staff person
OPEN
Choose an
with registration privileges
item.
Regulatory Associate
Organization or CTSU staff responsible N/A
Choose an
for regulatory processing
item.
Site Code Update
Common listserv for site code updates N/A
Choose an
Listserv
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 6/15/2016
Organization
Authorizer
ABTC
Joy Fisher
Alliance
Trini Ajazi
Alliance
Marcia Kelly
CIRB
Brian Campbell

June 2016

E-mail
[email protected]
[email protected]
[email protected]
[email protected]

Page 4 of 5

CTSU System Access Request Form (CSARF)
List of Authorizers as of 6/15/2016
Organization
Authorizer
COG
Michele Wilkins-Sanchez
COG
Kristin Coffan
CTSU (all others)
Martha Hering
CTSU (all others)
Ravi Rajaram
ECOG-ACRIN
Juanita Andrews
ECOG-ACRIN
Susan Lemont
NCIC-CTG
Corey Willman
NCIC-CTG
Lam Pho
NRG
Katie Campbell
NRG
Christine Gosik
NRG
Sharon Hartson Stine
NRG
Nancy Soto
PBTC
Aregahegn Negatu
SWOG
Connie Barnes

E-mail
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]

Internal Use Only
Date Received
Verify Authorizer
Date Processed

June 2016

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