Form AID 545-11 AID 545-11 DIS System Request Access Form

Development Information Solution
System Access Request Form
AUTHORITY:
PURPOSE:
ROUTINE USES:
DISCLOSURE:

Privacy Act Statement
Foreign Assistance Act (as amended), Foreign Affairs Reform and Restructuring Act, Executive Order 12163
To allow the Agency to collect information from prospective DIS users for provisioning them in DIS and giving access to DIS. Users need access
to DIS to manage the Agency’s portfolio, budget planning, performance management, and procurement planning.
Information collected is not shared outside of USAID.
Disclosure of this information to USAID is voluntary. However, failure to provide information requested could result in a request for access being
denied and the inability of the Agency to provide the user with an user account.

1. Type of Request
☐ Initial Request

2. Date (YYYYMMDD)

3. Access Requested for Bureau/Mission/Independent Office
(B/M/IO)

☐ Modification

4. Designation of USER
☐ USAID Workforce User – includes users who have an active USAID badge. Please fill out SECTION 1 and proceed to SECTION 3
☐ Implementing Partner User – includes users from implementing entities such as contractors, grantees, host government, or public
international organizations. Please fill out SECTION 2 and proceed to SECTION 3
SECTION 1 – USAID WORKFORCE USER INFORMATION
5. Name (Last, First, Middle Initial)

6. Work Telephone Number

7. Bureau/Mission/Independent Office

8. USAID Email Address

9. USAID Role(s) and Privileges Requested
☐ Operating Unit (OU) Activity Manager
☐ M&E
☐ OU Manager
☐ A&A Plan Edit
☐ A&A Plan Publish
☐ Budget Monitoring and Planning
☐ M&E
☐ OU Viewer
☐ A&A Plan
☐ M&E

☐ OU Project Manager
☐ M&E
☐ GIS Specialist
☐ M&E
☐ Operating Unit (OU) System Manager
☐ M&E
☐ Enterprise Administrator
(Washington based only)
☐ Application Administrator
(Washington based only)
☐ Enterprise Viewer
(Washington based only)
☐ Developer
(Washington based only)

10. Justification for role(s) and privilege(s)

ENDORSEMENT OF ACCESS BY USER’S SUPERVISOR

11. Supervisor Name

12. Supervisor Signature

13. Date (YYYYMMDD)

14. Supervisor’s Bureau/Mission/Independent

15. Supervisor’s Email Address

16. Supervisor’s Telephone Number

Office

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SECTION 2 – IMPLEMENTING PARTNER USER INFORMATION
17. Name (Last, First, Middle Initial)
18. Contact Telephone Number
19. Name of Implementing Partner Organization

20. Login.gov Username (address used for Login.gov access)

21. Award Number

22. Award Expiration Date (YYYYMMDD)

23. Access to Activities Requested

ENDORSEMENT OF ACCESS BY USER’S GOVERNMENT SPONSOR

24. A/COR Name

25. A/COR Signature

26. Date (YYYYMMDD)

27. A/COR’s Bureau/Office/Division

28. A/COR’s email address

29. A/COR’s Telephone Number

SECTION 3 – USER ACKNOWLEDGEMENT

30. Rules of Behavior
● Reminder for USAID Workforce Users – all Rules of Behavior for Users as
documented in the Agency’s Rules of Behavior for Users ADS 545mbd are
applicable.
● Additionally, the following Rules of Behavior are applicable for all DIS
Users:
1. The USER agrees to abide by all USAID policies, procedures, and guidelines
(including ADS 502, 503,505-508, 509, 510, 511, 516, 541, 545, 547, 549,
550-551, 578, 579) to protect USAID computer systems and data from misuse,
abuse, loss, or unauthorized access.
2. The USER agrees to collect, process, and share only unclassified information
on DIS.
3. The USER agrees to sign out of DIS at any time the USER's terminal will be
unattended by the USER (even for only a moment).
4. The USER agrees to give immediate notification to the DIS Help Desk when
there is a change in their employment status or change in job
responsibilities affecting their DIS access.
5. The USER agrees to access only those roles within DIS for which access
authorization by USAID was granted.
31. Training and Awareness Requirement
☐ I have completed or will complete the required ongoing DIS user training
32. User Signature

33. Date (YYYYMMDD)

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Instructions
(1) Type of Request: Initial request or a change of existing access (21) Award Number. Award number of the contract or grant of the
Implementing Partner. In case of agreements, list agreement
(2) Date: Date when the request is made
(3) Access Requested for Mission: Name of Mission for which number.
the user is requesting access. Use one form per Mission, unless
similar access is requested for multiple Missions.
(4) Designation of USER: Choose one of the options depending
on user designation – USAID users check the first box and follow
instructions; Implementing Partners check the second box and
follow the instructions. Limit choice to only one box.
SECTION 1: The following information is provided by USAID
user.
(5) Name: Last name, first name, and middle initial of the user.
(6) Contact telephone number of the user
(7) Bureau/Office/Division where the user belongs to
(8) USAID email Address. The user's official e-mail address.
(9a) Roles and Privileges requested by the user
(10) Justification. A brief statement is required to justify
establishment of initial user access. Provide appropriate
information if the user access is modified.
Endorsement by Supervisor or Sponsor: Official who endorses
user’s access to the Mission’s data.
(11) Supervisor Name
(12) Supervisor's Signature to confirm endorsement.
(13) Date. Date supervisor or sponsor signs the form
(14) Supervisor's Bureau/Office/Division. Supervisor's Bureau,
Office, Division (i.e. M/CIO)

(22) Award Expiration Date: End date of the Implementing
Partner’s award
(23) Access to Activities: Names of Mission activities for which
the user is requesting access.
Endorsement of access by User’s Government Sponsor:
Typically, the AOR or COR provides this endorsement.
(24) AOR’s or COR’s Name
(25) AOR’s or COR’s Signature to confirm endorsement.
(26) Date. Date AOR or COR signs the form
(27) AOR’s or COR’s Bureau/Office/Division
(28) AOR’s or COR’s email address
(29) AOR’s or COR’s telephone number if needed for
clarification
SECTION 3: User acknowledgement of Rules of Behavior and
Training requirements
(30) Rules of behavior – Users are expected to read and
acknowledge the documented rules of behavior.
(31) Training and Awareness Requirements. User must indicate if
he/she has completed the required DIS training.
(32) User Signature. By signing, the requestor understands that
they are responsible and accountable for their access to the
system.
(33) Date when the user signs the form.

(15) Supervisor's email address
(16) Supervisor's contact telephone number if needed for
clarification
SECTION 2: The following information is provided by
Implementing Partner user. One form per user per Mission
(17) Name. The last name, first name, and middle initial of the
user.
(18) Contact telephone number of the user
(19) Name of the Implementing Partner Organization. The user's
organization for whose work the access is to be granted.
(20) Login.gov Username: username used by the user to obtain
login.gov access credentials. Partner users MUST provide the
same email as used for login.gov

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