Updated: February 2016
Northeast Mississippi Community College
SSN ACCESS REQUEST
PLEASE PRINT INFORMATION
EMPLOYEE INFORMATION
Name of Employee: ____________________________________________________________________
Department: __________________________________________________________________________
NEMCC ID: _______________________________ BANNER ID: ________________________________
SSN ACCESS INFORMATION
Name of Report, File, or Screen: ___________________________________________________________
(May be the name of new file or report)
Please provide justification for SSN access:
Reason for Access: ______________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
REQUIRED APPROVALS
By signing, you acknowledge that you understand all Northeast Policies concerning SSN access and agree to abide
by those policies. Furthermore, you agree to put in place and/or follow practices to protect the security of data in the
files and reports requested.
Employee’s Signature: _________________________________________ Date: ____________________
I hereby acknowledge that the employee has read and understands the NEMCC Guidelines for Data Standards, Data
Integrity, and Security and that the above named Employee needs SSN Access as a requirement of employment.
Immediate Supervisor’s Signature: ______________________________ Date: ____________________
Executive Vice President’s Signature: ____________________________ Date: ____________________
COMPUTER CENTER
Access granted and confirmations sent to Supervisor, Executive Vice President, and User.
Access Granted by: ___________________________________________ Date: ____________________
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