Fillable NAFORM13170A ARMY (National Archives and Records Administration)

Fill Online, Printable, Fillable, Blank NAFORM13170A ARMY (National Archives and Records Administration) Form

Use Fill to complete blank online NATIONAL ARCHIVES AND RECORDS ADMINISTRATION (MD) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

NAFORM13170A ARMY (National Archives and Records Administration)

On average this form takes 6 minutes to complete

The NAFORM13170A ARMY (National Archives and Records Administration) form is 2 pages long and contains:

  • 0 signatures
  • 9 check-boxes
  • 19 other fields

Country of origin: US
File type: PDF

U.S.A. forms for National Archives and Records Administration

BROWSE NATIONAL ARCHIVES AND RECORDS ADMINISTRATION (MD) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
INSTRUCTION AND INFORMATION SHEET FOR NA FORM 13170A
ARCIS MRS MTF CUSTOMER PORTAL USER ACCOUNT REQUEST
STEP 1: Specify Action Requested.
Check appropriate box – Create New User, Modify Existing User, or Delete User.
STEP 2A: ARCIS MTF User Information
Provide ALL MTF User information requested including e-mail address. Please provide ALL MTF address
information requested, including the DMIS ID.
STEP 2B: Specify Level of Access and Sign & Date Request
Access Level: Check the appropriate box for the level of access requested.
User Signature & Date: The user must sign and date the form. By signing, the user accepts the Terms of
Use.
STEP 3: Submission of Application to Service Branch POC.
Applicant should forward this form to the service branch POC designated to authorize new ARCIS MRS MTF
Customer Portal users. If you do not know who this person is, please contact the ARCIS help desk at
arcishelp@nara.gov or (314) 801-9300.
STEP 4: Service Branch POC Authorization Information and Access Level
Service Branch POC Authorization Information: Please provide information about the Service Branch
POC authorizing request for action.
STEP 5: Submission of Application to NARA
The Service Branch POC designated to authorize new ARCIS MRS MTF Customer Portal users should e-
mail this completed application from their.mil e-mail account to arcishelp@nara.gov. By emailing a scanned
copy of this form with the user’s signature, the Service Branch POC is authorizing the request. Please do
not
mail or fax this form.
STEP 6: Receipt of login information and verification and approval of application
NPRC staff will verify the information in the application, notify the Service Branch POC designated to
authorize new ARCIS MRS MTF Customer Portal users that the new user has been added, and e-mail the
user ID and password to the new user. Users should be able to log in to ARCIS immediately.
TERMS OF USE: The ARCIS MRS MTF Customer Portal is an online file upload system that allows
authorized users to submit shipment data files (SDF) and record index files (RI) to the National Personnel
Records Center (NPRC) as a part of the process of retiring inactive medical records to the National
Archives and Records Administration (NARA). Only those designated as authorized users should access
the ARCIS MRS MTF Customer Portal in accordance with their official duties. Unauthorized system
access or improper use may subject user to disciplinary action or prosecution under applicable Federal
laws. Your ARCIS userid and password must be protected at all times and not shared with others.
Sharing your account information with others is a violation of NARA security policy and may result in
system access being revoked.
NARA Federal Records Centers
Archives and Records Centers Information System (ARCIS)
ARCIS MRS MTF Customer Portal User Account Request
STEP 1: SPECIFY ACTION REQUESTED
Action Requested: Create New User
Modify Existing User
Delete User
STEP 2A: ARCIS MTF USER INFORMATION
Please provide information about the user whose account requires the action requested in Step 1.
Name: Last: First: Middle Initial:
Office Phone: Commercial Phone: - - Ext.
E-mail Address: Job Title:
Military Treatment Facility (MTF) Name:
DMIS ID:
Record Group: please check box
for appropriate service branch
Air Force – 342
Army -
338
Navy – 052
DHA – 330
MTF Mailing Address:
STEP 2B: SPECIFY LEVEL OF ACCESS AND SIGN & DATE REQUEST
Specify the level of system access required: Check all that applies (leave blank for delete user requests)
Level I - Ability to view and upload SDF and RI files submitted by MTF user
Level II Ability to view SDF and RI files for all Navy MTFs
User Signature & Date:
By si
gning, you agree to the TERMS OF USE. Authorized access is granted for official duties. Information should
not be shared, transferred or provided to unauthorized personnel.
STEP 3: SUBMISSION OF APPLICATION TO SERVICE BRANCH POC
Applicant should forward this form to the Service Branch POC designated to authorize new ARCIS MRS MTF Customer
Portal users. If you do not know who this person is, please contact the ARCIS help desk at
arcishelp@nara.gov or
(314) 801-9300.
STEP 4: SERVICE BRANCH POC AUTHORIZATION INFORMATION AND ACCESS LEVEL
Please provide information about the Service Branch POC authorizing request for action.
Name: Last:
- - E
First: Middle Initial:
Office Phone/Fax: Commercial Phone: xt.
Job
Commercial Fax: - -
E-mail Address: Title:
STEP 5: SUBMISSION OF APPLICATION TO NARA
The Service Branch POC designated to authorize new ARCIS MRS MTF Customer Portal users should e-mail this
completed application from their .mil e-mail account
to arcishelp@nara.gov. By e-mailing a scanned copy of this form with
the users signature, the Service Branch POC is authorizing the request. Please do not
mail or fax this form.
STEP 6: RECEIPT OF LOGIN INFORMATION AND VERIFICATION AND APPROVAL OF APPLICATION
NPRC staff will verify the information in the application, notify the Service Branch POC designated to authorize new ARCIS
MRS MTF Customer Portal users that the new user has been added, and e-mail the user ID and password to the new user.
Users should be able to log in to ARCIS immediately.
NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NA FORM 13170A (10-14)
Form is available online at http://archives.gov/st-louis/military-personnel/agencies/medical-registry-system.html
Burrell
Bryan
K
N/A
bryan.k.burrell2.civ@mail.mil
Med Rcds Admin, Patient Admin Div, PCI
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

NAFORM13170A ARMY (National Archives and Records Administration)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 25 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document