Request for MIS Hardware, Software and Services
You can access this form by clicking on Request for MIS Hardware, Software and Services
Instructions to Complete the Request
Requester Block
- Write name of staff person requesting/reporting in CIRAS.
- Division - Leave Blank
- Bureau/Facility - Leave Blank
- Telephone No - Leave Blank
- Contact - Give information for requestor/reporter name; address; city/zip; phone number.
- State Fiscal Year - Insert current State Fiscal Year.
Recipient Block
Leave the entire block blank (that is Recipient through *Required Estimated Total Cost)
Narrative Description of Request Block
Write as applicable:
"Illinois driver's license will not verify," and then write license number
or
"Requestor has out-of-state license,"
and then write state and license number
Justification
Write in the Justification box: "DHS.G.CIRAS_ISCProviderExternalReporting, Required for reporting."
Page Two
All fields should be left blank.
Completion
Once completed, both pages of the form must be emailed to DHS.DDD.CIRAS@illinois.gov
