US Dept of Housing and Urban Development 7/19/2021

OMB Approval No.2506-0171 exp 09/30/2023 IDIS O n L i n e Access Request Privacy Act Statement:Public Law 97-255,Financial Integrity collect ct1 U.S.C.3In12,or authorizes the Department of Housing and Urban Development(HUD)to collect all the information which will be used by HUD to protect disbursement data from fraudulent actions. The purpose of the data is to safeguard the Integrated Disbursement and Information System U.S. Department of Housing and Urban Development (IDIS)from unauthorized access.The data are used to ensure that individuals who no longer Office of Community Planning and Development require access to IDIS have their access capability promptly deleted.This information will not be otherwise disclosed or released outside of HUD,except as permitted or required by law. Failure to provide the information requested on the form may delay the processing of your approval for access to IDIS. Public Reporting burden for this information collection Is estimated to average 30 minutes including time for collecting,reviewing,and reporting data.HUD may not collect this information,and respondents are not required to complete this form,unless it displays a currently valid OMB Control Number. GRANTEE & REQUESTOR INFORMATION REQUEST TYPE Role to be Performed by Headquarters Role to be Performed by Field or Local IDIS Administrator New Request 17Z Drop from IDIS ❑ Renew Lapsed ID ❑ Change Function or Program Area ❑ Change Name ❑ Add Access for Another Grantee ❑ Please create a five digit pin that will be used for password resets. O❑FV ,rt J to jJ Requestor's Name(Last, First, MI): Office E-mail Address: Dorway,Vicki E. vdorway@everettwa.gov Office Address: Office Phone: ext.: 2930 Wetmore Avenue,Suite 8A, Everett,WA 98201 425-257-7185 Grantee Name in IDIS: GRANTEE TYPE Everett WA City VI County ❑ State ❑Non-Profit Sub Grantee* ❑ __....._--------------- Please Mark All Necessary Functions&Programs Authorized Set Up Activity VI Request Drawdown Functions Approve Drawdown Local IDIS Administrator VI Program CDBG VI HOME ❑ ESG ❑ HOPWA ❑ Lreas HESG ❑ HOPWA-C ❑ HTF ❑ Other: If other,please specify name of program *Approval of State Sub Grantee Request—CPD State Coordinator or State Official name,signature and date: Name: Signature: Date: odules Con Plan: Create/Edit/Submit l Edit rAll View Caper: Create/Edit/Submit Edit View IDIS Online Rules of Behavior September 14,2015 Introduction This Rules of Behavior(RoB)procedure was developed as a guide to ensure that all users of IDIS Online are made aware of their security responsibilities before accessing IDIS Online.The RoB defines responsibilities and procedures for secure use of IDIS Online. By reading and acknowledging these rules, users accept the responsibility to protect IDIS Online and data. Users are accountable for their actions and the requirements to protect IDIS Online data and equipment from both malicious and accidental loss and damage. These rules clearly delineate the responsibilities of and expectations for all individuals with access to IDIS Online. Non-compliance with these rules will be enforced through sanctions commensurate with the level of infraction. Responsibilities All authorized users who have access to IDIS Online are required to read,acknowledge understanding,and sign the RoB before accessing IDIS Online and associated data. This acknowledgement must be completed annually thereafter. By agreeing to and signing these rules,the user signifies: 1. Understanding that access is given only to IDIS Online to which the user requires access in the performance of their official duties and the user will not attempt to access systems they are not authorized to access. ALL PREVIOUS VERISONS OF THIS FORM WILL NOT BE ACCEPTED OR PROCESSED. HUD FORM 27055(10/2020) Page 1 of 3