Form OTECH258 "Racf Customer Authorization" - California

What Is Form OTECH258?

This is a legal form that was released by the California Department of Technology - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2017;
  • The latest edition provided by the California Department of Technology;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form OTECH258 by clicking the link below or browse more documents and templates provided by the California Department of Technology.

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Download Form OTECH258 "Racf Customer Authorization" - California

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STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF TECHNOLOGY
OFFICE OF TECHNOLOGY SERVICES
RACF CUSTOMER AUTHORIZATION
OTECH 258 (REV. 02/2017)
Department:
Department Prefix:
Name:
Information Security Officer (ISO) Name:
Address:
Phone Number:
Email Address:
Alternate ISO Name (if any):
Address:
Phone Number
Email Address:
Authorized RACF Coordinators/Administrators
RACF Coordinator Name:
Address:
Phone Number
Email Address:
Alternate 1 RACF Coordinator Name:
Address:
Phone Number:
Email Address
Alternate 2 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
Alternate 3 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
Information Security Officer Approval
Name (Print):
Date:
Signature:
Title:
E-Mail Address:
Phone Number:
SUBMIT THE COMPLETED AND SIGNED FORM TO
SECURITY OPERATIONS BY UPLOADING THIS DOCUMENT INTO YOUR REMEDY TICKET
If you have any questions, please email Security Operations at:
Security_Ops@STATE.ca.gov
NOTE: Complete page 2 only if there are more than three (3) authorized RACF Coordinators/Administrators.
1
STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF TECHNOLOGY
OFFICE OF TECHNOLOGY SERVICES
RACF CUSTOMER AUTHORIZATION
OTECH 258 (REV. 02/2017)
Department:
Department Prefix:
Name:
Information Security Officer (ISO) Name:
Address:
Phone Number:
Email Address:
Alternate ISO Name (if any):
Address:
Phone Number
Email Address:
Authorized RACF Coordinators/Administrators
RACF Coordinator Name:
Address:
Phone Number
Email Address:
Alternate 1 RACF Coordinator Name:
Address:
Phone Number:
Email Address
Alternate 2 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
Alternate 3 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
Information Security Officer Approval
Name (Print):
Date:
Signature:
Title:
E-Mail Address:
Phone Number:
SUBMIT THE COMPLETED AND SIGNED FORM TO
SECURITY OPERATIONS BY UPLOADING THIS DOCUMENT INTO YOUR REMEDY TICKET
If you have any questions, please email Security Operations at:
Security_Ops@STATE.ca.gov
NOTE: Complete page 2 only if there are more than three (3) authorized RACF Coordinators/Administrators.
1
Complete this section only if there are more than three (3) authorized RACF Coordinators/Administrators.
Continued - Authorized RACF Coordinators/Administrators
Alternate 4 RACF Coordinator Name:
Address:
Phone Number:
Email Address
Alternate 5 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
Alternate 6 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
Alternate 7 RACF Coordinator Name:
Address:
Phone Number:
Email Address
Alternate 8 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
Alternate 9 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
Alternate 10 RACF Coordinator Name:
Address:
Phone Number:
Email Address:
2
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