Form NS-30 "Lsi Security Change Request Form" - Louisiana

What Is Form NS-30?

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

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Louisiana Division of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NS-30 by clicking the link below or browse more documents and templates provided by the Louisiana Division of Administration.

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Download Form NS-30 "Lsi Security Change Request Form" - Louisiana

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Click for Instructions
Send
Louisiana Office of Technology Services Network Services
LSI Security Change Request Form (NS-30)
Only agency-authorized contacts can request firewall changes.
1. Requester's Name (Printed)
2. Requester's Phone#
3. Requester's Email
4. Department
5. Division
6. Change Category
7. Proposed Change
Date
Normal
Emergency
8. Requested Changes:
Source Address
Source Port
Destination Address
Destination Port
Action
Add/Remove Rule
Reason for Change(s)
Deny/Accept
Adding web access to web server
Ex.
Any
Any
192.222.222.2
80 TCP
Deny
Accept
Add
Remove
in DMZ from any outside source
a
Deny
Accept
Add
Remove
b
Deny
Accept
Add
Remove
c
Deny
Accept
Add
Remove
d
Deny
Accept
Add
Remove
9. Request/remove static address assignment for:
Private IP Address
Translated to Public Address
Private IP Address
Translated to Public Address
a
a
c
c
b
b
d
d
10. Description of what you are trying to accomplish (use additional pages if needed):
11. Authorized Requester's Signature, Title
12. Date
The following section is to be completed by OTS-NS staff:
1. Change Request Security Review Results
2. Change Request Results: Approved/Denied, and Comments
3. Scheduled by
4. Date
5. Time
6. Back-out File Name
7. Request Closed by
8. Date
9. Time
Use Acrobat Reader to open the form, then use the Send button above to submit online OR email the completed form to
NS-30 (03/17)
otm-lsi-security@listserv.doa.la.gov
Click for Instructions
Send
Louisiana Office of Technology Services Network Services
LSI Security Change Request Form (NS-30)
Only agency-authorized contacts can request firewall changes.
1. Requester's Name (Printed)
2. Requester's Phone#
3. Requester's Email
4. Department
5. Division
6. Change Category
7. Proposed Change
Date
Normal
Emergency
8. Requested Changes:
Source Address
Source Port
Destination Address
Destination Port
Action
Add/Remove Rule
Reason for Change(s)
Deny/Accept
Adding web access to web server
Ex.
Any
Any
192.222.222.2
80 TCP
Deny
Accept
Add
Remove
in DMZ from any outside source
a
Deny
Accept
Add
Remove
b
Deny
Accept
Add
Remove
c
Deny
Accept
Add
Remove
d
Deny
Accept
Add
Remove
9. Request/remove static address assignment for:
Private IP Address
Translated to Public Address
Private IP Address
Translated to Public Address
a
a
c
c
b
b
d
d
10. Description of what you are trying to accomplish (use additional pages if needed):
11. Authorized Requester's Signature, Title
12. Date
The following section is to be completed by OTS-NS staff:
1. Change Request Security Review Results
2. Change Request Results: Approved/Denied, and Comments
3. Scheduled by
4. Date
5. Time
6. Back-out File Name
7. Request Closed by
8. Date
9. Time
Use Acrobat Reader to open the form, then use the Send button above to submit online OR email the completed form to
NS-30 (03/17)
otm-lsi-security@listserv.doa.la.gov