ࡱ> provy pQbjbj 8\{{gz ZZ8D"X(:@@@WWWWWWWZ\W9<T@"<<WZZ@@W"""<Z@Z8@W"<W""K O@h'RZM<WW0"XM^R^xOO8^5PX" XWW!"X<<<<^ :  Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Department for Community Based Services (DCBS) Division of Child Care (DCC) Kentucky Integrated Child Care System (KICCS) STARS Portal Access Agreement Form and Online Request Instructions General Procedure Step 1: Print this form. Step 2: Follow the instructions available on the Portal Launch at http://chfs.ky.gov/dcbs/dcc/kiccsportal/ site to create a citizen account thru the Kentucky Online Gateway. If you have an existing citizen account, complete this form and contact your STARS administrator. If you need help completing the online request, contact the KICCS HelpDesk (502) 564-0104, option 6 or toll free at 866-231-0003 Option 6. Step 3: Complete ALL applicable fields on this form. Handwritten information must be legible. Access will not be granted if the user information is incomplete or illegible when the form is submitted. Step 4: This completed form and a copy of your University of Kentucky issued employee photo ID must be sent by fax to 502-564-3464 or e-mail to  HYPERLINK "mailto:portal.access@ky.gov" portal.access@ky.gov. In the subject line type ATTN: STARS Portal Administrator. IMPORTANT: Please enlarge and lighten your ID before faxing it to make the image easier to read. For questions or assistance, please call the help desk at (502) 564-0104, option 6 or toll free at 866-231-0003 Option 6. If you prefer, you may mail these documents to: Division of Child Care, 275 E. Main St, 3C-F, Frankfort, KY 40621, ATTN: STARS Portal Administrator. Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Department for Community Based Services (DCBS) Division of Child Care (DCC) Kentucky Integrated Child Care System (KICCS) STARS Portal Account Agreement This form must be completed and returned to access the KICCS/ STARS Portal Account. It must be completed in ink or typed. All information must be accurate and complete, and the form must contain the appropriate authorized signature(s). The completed form SHOULD BE submitted electronically for approval to CHFS at fax number 502-564-3464 or emailed to:  HYPERLINK "mailto:portal.access@ky.gov" portal.access@ky.gov. If you prefer, you may mail these documents to: Division of Child Care, 275 E. Main St, 3C-F, Frankfort, KY 40621, ATTN: STARS Portal Administrator. Section 1: User Information Request Date: __________ University of Kentucky Employee ID No.______________________________ First Name: __________________________ M.I. _____ Last Name: Email used on KOG:_______________________________________________________________________ Primary Phone: ( ) ___ Secondary Phone: (___) Enter name of the Head of Organization/Owner: ___Quality Enhancement Initiative (QEI)_ Organization Name: ___________________________________ Local Fax Number: ________________ Physical Mailing Address: City: ____________________State _____ Zip: __________________County: Section 2: KICCS STARS Portal Account User Agreement By accepting this user agreement, I acknowledge that I have been made aware of my responsibilities to protect the confidentiality of the information in the KICCS STARS Portal Account. I am only permitted to use the KICCS STARS Portal Account for the purpose of authorized business actions in reviewing/submitting application documentation to the Division of Child Care/STARS for KIDS NOW program in Kentucky. I acknowledge that I have been made aware that misuse of the information may potentially lead to penalties and/or system revocation. As an authorized user, I agree to the following terms of use: I agree to make only authorized use of any information in the KICCS STARS Portal Account. I agree to not divulge the contents of any record except as permitted by state or federal law. I agree to not share any user name or password information. I acknowledge that I am responsible for any actions taken on the KICCS STARS Portal Account under my login name. I agree not to access the information contained in the KICCS STARS Portal Account other than for authorized business actions. I agree to terminate my access to the KICCS STARS Portal Account when my employment with the reporting entity ends or when my job responsibilities no longer require me to access KICCS STARS Portal Account information. I agree to immediately report any misuse of the KICCS STARS Portal Account or violations of this agreement to the Department for Community Based Services or the CHFS IT Security Officer. Commonwealth of Kentucky Cabinet for Health and Family Services (CHFS) Department for Community Based Services (DCBS) Division of Child Care (DCC) Kentucky Integrated Child Care System (KICCS) STARS Portal Account Agreement Any misuse of the KICCS STARS Portal Account or its information may lead to temporary revocation of access privileges, permanent loss of access privileges or penalties under state and/or federal law. Section 3: Authorization Signature for All Account Requestors I attest to the best of my knowledge that the information provided above is true, accurate, and complete and that I have read and agree to the KICCS STARS Portal Account user agreement on page 1 of this document. % ____________________________________________________________%_________________________ User signature here DATE Your Printed Name (must be legible): __ %_____________________________________________________________%_______________________ Your administrator signature here (if you are the QEI SUPERVISOR OR admin, sign here) DATE Your Administrator Printed Name (must be legible): _ Section 4 is for the Division of Child Care staff only. Do not write below this line.  Section 4: Authorization Signature(s) for STARS Administrators Only I certify that the job duties of the user requires access to the program(s) requested and that the access complies with appropriate use as specified in the KICCS STARS ! 6 7 8 > I K ޲ޠo^^L^o=o^hJT5CJOJQJ^JaJ#h VhJT6CJOJQJ^JaJ h VhJTCJOJQJ^JaJ#h VhJT5CJOJQJ^JaJhJTCJOJQJ^JaJ hXhJTCJOJQJ^JaJ#hXhJT5CJOJQJ^JaJh#5CJOJQJ^JaJh} CJOJQJ^JaJh#:5CJOJQJ^JaJh} 5CJOJQJ^JaJ#hJ/hoq5CJOJQJ^JaJIx   7 8 h]h^gdJT h]h^gdJT & F h]h^gdJT hh@&]h`hgd} $hh@&]h`ha$gd} gd} $a$gd} $@&a$gd}    *+zidgdu h]h^gdu h]h^gd} $h-DM ]h^a$gdJT h]h^gdJT h8]h^8gdJT & F h]h^gdJTh]hgdJT & Fh]h^gdJT h]h^gdJT 6 9 y  ( 6 7 ` a u v ͽͫttatPBPBPBh^"CJOJQJ^JaJ hJ/h^"CJOJQJ^JaJ$h^"hJT0JCJOJQJ^JaJ)jh^"hJTCJOJQJU^JaJ h^"h CJOJQJ^JaJ h^"hJTCJOJQJ^JaJ#h^"hJT5CJOJQJ^JaJhJTCJOJPJQJ^JaJhJTCJOJQJ^JaJ&h VhJT56CJOJQJ^JaJ h VhJTCJOJQJ^JaJ { *+./´ªtetStB1 hJ/hCJOJQJ^JaJ hJ/h& 2CJOJQJ^JaJ#hJ/h*?m5CJOJQJ^JaJh 5CJOJQJ^JaJ#hJ/hG 5CJOJQJ^JaJ#hJ/h25CJOJQJ^JaJ#hJ/ho5CJOJQJ^JaJhuOJQJ^Jh|pCJOJQJ^JaJh} CJOJQJ^JaJhJThJTCJOJQJ^JaJhJT5CJOJQJ^JaJh^"hJT5OJQJ^J+,-/HvOk$ |)0$@&a$gd9wS$ |)x0$@&a$gd9wS $ |)@&a$gdDr h]hgd*j$a$gdG $a$gdG  $@&a$gdz $@&a$gdG gd" hh]h`hgdoh8]h^8`gd|,9OTU\cd б~mޏ\K hhiCJOJQJ^JaJ hJ/hu&,CJOJQJ^JaJ hJ/hQCJOJQJ^JaJ hJ/h CJOJQJ^JaJ hJ/hvCJOJQJ^JaJ hJ/hG CJOJQJ^JaJ hJ/h*?mCJOJQJ^JaJhmBqCJOJQJ^JaJh#:CJOJQJ^JaJ hJ/h aCJOJQJ^JaJ hJ/h& 2CJOJQJ^JaJ3?CXbetuͼޫ͚̓q\qI7#hiB*CJOJQJ^JaJph$h}AhJT0JCJOJQJ^JaJ)hJThJTB*CJOJQJ^JaJph#hJTB*CJOJQJ^JaJph,jhJTB*CJOJQJU^JaJph hJ/hAuCJOJQJ^JaJ hJ/h aCJOJQJ^JaJ hJ/hS.CJOJQJ^JaJ hJ/hG CJOJQJ^JaJ hJ/h& 2CJOJQJ^JaJ hh& 2CJOJQJ^JaJ278?MNOZjk 569efӿqbqbqNqbqbqbq&h33h9wS:>*CJOJQJ^JaJh9wS:CJOJQJ^JaJ#h33h9wS:CJOJQJ^JaJ&hJ/hX]5:CJOJQJ^JaJ&hJ/hQ5:CJOJQJ^JaJ&hJ/hu&,5:CJOJQJ^JaJ&hJ/hUR5:CJOJQJ^JaJh#:CJOJQJ^JaJhURCJOJQJ^JaJ hJ/hURCJOJQJ^JaJ fg*P DE$a$gdz $0$@&a$gdDr $0$@&a$gd33 $0$a$gd33$ |)x0$@&a$gdl| |)x0$@&gd<$ |)0$@&a$gd9wS |)0$@&gd9wS |)x0$@&gd9wS |)gd9wSfgv"ڴ~lXD0&hM}hM}:>*CJOJQJ^JaJ&hM}hwZ:>*CJOJQJ^JaJ&hM}ht3:>*CJOJQJ^JaJ#h33hwZ:CJOJQJ^JaJ#h33h<:CJOJQJ^JaJ#h33ht3:CJOJQJ^JaJ#h~ht3:CJOJQJ^JaJ#h~h33:CJOJQJ^JaJ&h33h9wS:>*CJOJQJ^JaJ#h33h9wS:CJOJQJ^JaJ&hjh9wS5:CJOJQJ^JaJ")*OP]adq{³}n\M;,h(i:CJOJQJ^JaJ#h33hl:CJOJQJ^JaJh:CJOJQJ^JaJ#h33h2 [:CJOJQJ^JaJhZu:CJOJQJ^JaJ#h33ht3:CJOJQJ^JaJ#h33h$n:CJOJQJ^JaJ#h33hj:CJOJQJ^JaJh#::CJOJQJ^JaJh9wS:CJOJQJ^JaJhS:CJOJQJ^JaJh<:CJOJQJ^JaJ hM}:>*CJOJQJ^JaJ    %&-CDɷɥnZIZ5Zn&hJ/h*?m5:CJOJQJ^JaJ h 5:CJOJQJ^JaJ&hJ/hM5:CJOJQJ^JaJ&hJ/h a5:CJOJQJ^JaJ hz5:CJOJQJ^JaJ#h33hC:CJOJQJ^JaJ#h33h~{:CJOJQJ^JaJ#h33h:CJOJQJ^JaJ#h33h a:CJOJQJ^JaJ#h33hQ:CJOJQJ^JaJ#h33hS:CJOJQJ^JaJD"#()07KDJOPW_=CIPWXl޿Ю޿޿޿޿Нп hJ/hl|CJOJQJ^JaJ hJ/hVCJOJQJ^JaJ hJ/hmBqCJOJQJ^JaJ hJ/h*?mCJOJQJ^JaJhmBqCJOJQJ^JaJ hJ/hWCCJOJQJ^JaJ hJ/h aCJOJQJ^JaJ2Eef_ e !";i $0$@&a$gdJ5 $0$a$gdx $0$a$gdG $a$gdx $@&a$gdx $ & Fa$gdU$a$gdz$a$gdUlmp|!"!῱qbqPq>b>#hJ/hG 5CJOJQJ^JaJ#hJ/h*?m5CJOJQJ^JaJhmBq5CJOJQJ^JaJ#hJ/hx 5CJOJQJ^JaJhj5CJOJQJ^JaJh47CJOJQJ^JaJ hJ/h*?mCJOJQJ^JaJhmBqCJOJQJ^JaJ hJ/hVCJOJQJ^JaJ hJ/hKCJOJQJ^JaJ hJ/h aCJOJQJ^JaJh$nCJOJQJ^JaJ4@JLZhjdzǟ}l^lMl<}< hJ/h aCJOJQJ^JaJ hJ/h*?mCJOJQJ^JaJhmBqCJOJQJ^JaJ hJ/hVCJOJQJ^JaJ hJ/hrzCJOJQJ^JaJ hJ/hX]CJOJQJ^JaJ&hJ/h  5:CJOJQJ^JaJ&hJ/hu&,5:CJOJQJ^JaJ&hJ/h a5:CJOJQJ^JaJ&hJ/hV5:CJOJQJ^JaJ hJ/hx CJOJQJ^JaJtNPR j k gdl $ x0$gdgdQVx&#$+D/@&gdVnn$ $ 0$a$gdS$ $ x0$a$gd$x0$]a$gdlt$LNͼͼxgxgUD3 hVnn5>*CJOJQJ^JaJ hS5>*CJOJQJ^JaJ#hJ/hVnn6CJOJQJ^JaJ hJ/hVnnCJOJQJ^JaJhSCJOJQJ^JaJ&hJ/hX]5:CJOJQJ^JaJ h 5:CJOJQJ^JaJ hmBq5:CJOJQJ^JaJ hS5:CJOJQJ^JaJ&hJ/h5:CJOJQJ^JaJ hJ/hjJCJOJQJ^JaJhX]CJOJQJ^JaJNP     " 2 6 C T U V ­o^M^o9&hlh5:CJOJQJ^JaJ h^5:CJOJQJ^JaJ hmBq5:CJOJQJ^JaJ&hlhS5:CJOJQJ^JaJ) *h hA75:CJOJQJ^JaJ) *h h?5:CJOJQJ^JaJ) *h h5:CJOJQJ^JaJ# *hS5:CJOJQJ^JaJ h\5:CJOJQJ^JaJ&hJ/h5:CJOJQJ^JaJ hQVhQVV e i j k ~ !Dzm\KG?h~hl5hl hVnn5>*CJOJQJ^JaJ hS5>*CJOJQJ^JaJ#hJ/hVnn6CJOJQJ^JaJ#hlhVnn6CJOJQJ^JaJ# *h hVnnCJOJQJ^JaJ *hSCJOJQJ^JaJ) *h h^5:CJOJQJ^JaJ h Y15:CJOJQJ^JaJ&hlh5:CJOJQJ^JaJ&hlhS5:CJOJQJ^JaJ !!R!S!!P"P#PjPlPmPoPpPrPsPuPvPxPyPP$a$gd$ngdogd $0$a$gdwZh]hgd8"$x0$@&]a$gdJ5$x0$]a$gdV2$a$gdl ! !!8!=!>!?!Q!R!S!x!y!!!!!!PPκp_Q_@_@20@Uh^CJOJQJ^JaJ hJ/hwZCJOJQJ^JaJhw+CJOJQJ^JaJ hJ/h$CJOJQJ^JaJ hJ/hKCJOJQJ^JaJ&hJ/hX]56CJOJQJ^JaJ&hJ/hs5:CJOJQJ^JaJ h^5:CJOJQJ^JaJ&hJ/hC5:CJOJQJ^JaJ&hJ/hC56CJOJQJ^JaJ:jhJ/hC56CJOJQJU^JaJmHnHu Portal Account User Agreement. STARS Administrator: ___________________________________ Date:      STARS Portal Account Rev.  DATE \@ "MMMM d, yyyy" April 17, 2014  Page  PAGE 1 of  NUMPAGES 4 Cabinet for Health and Family Services (CHFS) Department for Community Based Services (DCBS) TWIST PCC Tracking Module User Agreement PPPPPP P!P"P#P(P)P6P\P]P^PcP´~jVD2V#hJ/h:CJOJQJ^JaJ#hJ/h>*CJOJQJ^JaJ&hJ/h5:CJOJQJ^JaJ&hJ/h*CJOJQJU^JaJmHnHu&hJ/h56CJOJQJ^JaJ#hJ/h>*CJOJQJ^JaJ#hJ/h5CJOJQJ^JaJPPPPPPPPQDQmQnQoQpQgdo$a$gdTyv$a$gd  !|)gd% 0*gd"$a$gd $ a$gd PPPPPPPPPPPPPPPPPPPPPPQlQ±띅oYUG<h5:CJaJh}9h5:CJaJh+h56CJOJQJ^JaJmHnHu+h56CJOJQJ^JaJmHnHu/jh%h56CJOJQJU^JaJ&h%h56CJOJQJ^JaJ hhCJOJQJ^JaJhCJOJQJ^JaJ4jhhCJOJQJU^JaJmHnHuh hbhCJOJQJ^JaJlQmQnQoQpQ hJ/hUCJOJQJ^JaJhhh}9h5:CJaJ6&P1h:pj/ =!"#$% ^# 666666666vvvvvvvvv66666686666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH <`< 8"NormalCJ_HmH sH tH B@B & 2 Heading 1$$@&a$5CJDA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 44 & 20Header  !2B@2 & 2 Body TextCJR"@R & 2Caption%$x*&#$+DA/0$a$54 @"4 & 20Footer  !.)1. & 2 Page Number2>@B2 & 2Title$a$5>*RRRR >Body Text Indent 2hdx^hjcj " Table Grid7:V0RY@rR l| Document Map-D M OJQJ^JH@H K Balloon TextCJOJQJ^JaJ6U`6 0 Hyperlink >*B*phb@b LB List Paragraphd^m$CJOJPJQJaJFV`F +40FollowedHyperlink >*B*ph2o2 $0 Header CharCJ2o2 $n0 Footer CharCJB'`B #0Comment ReferenceCJaJ8@8 #0 Comment TextCJ:: #0Comment Text Char@j@@ "#0Comment Subject!5\Fo!F !#0Comment Subject Char5\PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] jj\ QUy| f"DlNV !PcPPlQpQ !#$%')*,- +E PpQ"&+6`utjXX&?N[bditv|!L @ (    0Ԕ0e0e#" `? 4(  z  <Ԕ1d"?z  <Ԕ1d"?B S  ?/@ djh%t%tQ|eKq% 4 DkGk>*urn:schemas-microsoft-com:office:smarttags PersonName ?)vefgijlmoprshk    ' ) gijlmoprshk3333++tk  ) 2 2 O P a d } } % lm6C8=>?xy"ggijjlmoprsgghk++tk  ) 2 2 O P a d } } % lm66;C8=>?xy"ggijjlmoprsgghkX& 64Ps&0f!~0fk0f{ :0f+gp7(&& f"0f+#0ft $0f:+B/׀80fnD0fKʘui`Y`~p[P(#B\^yg{_dj}l~vi2tZDSyh}0f$_~0f~$X} #hh^h`CJOJQJo(qh8^8`OJQJo(hHh^`OJQJ^Jo(hHoh ^ `OJQJo(hHh ^ `OJQJo(hHhx^x`OJQJ^Jo(hHohH^H`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhh^h`8B*CJOJQJTXo(qhh^h`8B*CJOJQJTXo(qhh^h`8B*CJOJQJTXo(qhh^h`8B*CJOJQJTXo(qh^`OJQJo(hH ^`hH. pp^p`hH. @ @ ^@ `hH. ^`hH. ^`hH. ^`hH. ^`hH. PP^P`hH.hh^h`CJOJQJo(qhh^h`OJQJo(hHh8^8`OJQJo(hH ^`OJQJo(  ^ `OJQJo( ^ `OJQJ^Jo(o x^x`OJQJo( H^H`OJQJo(^`OJQJ^Jo(o ^`OJQJo(hh^h`8B*CJOJQJTXo(qhh^h`8B*CJOJQJTXo(qhh^h`8B*CJOJQJTXo(qh^`OJQJo(hHhTT^T`OJQJ^Jo(hHoh$ $ ^$ `OJQJo(hHh  ^ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhdd^d`OJQJo(hHh44^4`OJQJ^Jo(hHoh^`OJQJo(hHhh^h`8B*CJOJQJTXo(qhh^h`8B*CJOJQJTXo(qh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hHh ^ `OJQJo(hHh^`OJQJ^Jo(hHoh!^!`OJQJo(hHh^`OJQJo(hHh  ^ `OJQJ^Jo(hHoh  ^ `OJQJo(hHhxx^x`OJQJo(hHhHH^H`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHhp^p`OJQJ^Jo(hHoh@ ^@ `OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHhP^P`OJQJ^Jo(hHoh ^ `OJQJo(hHhh^h`CJOJQJo(hHq^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hH^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.h8^8`OJQJo(hH^`OJQJ^Jo(hHo ^ `OJQJo(hH ^ `OJQJo(hHx^x`OJQJ^Jo(hHoH^H`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hHhh^h`CJOJQJo(hHq^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hHh^`OJQJo(hHh@ @ ^@ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhPP^P`OJQJo(hHh  ^ `OJQJ^Jo(hHoh^`OJQJo(hHhh^h`8B*CJOJQJTXo(qhh^h`8B*CJOJQJTXo(qh^`OJQJo(hHh  ^ `OJQJ^Jo(hHoh  ^ `OJQJo(hHhxx^x`OJQJo(hHhHH^H`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhh^h`CJOJQJo(q7(&Xh}nD&k"+#{ :t $!~8$_~i2t#B\^g{_i`YDSy~:+B/6K}l+gp[                                                               &                           &                           U wX5Vr 8+]zV_[&n w+"YY F : ;  ) :O Qu  5 O9 lt x ]V g@Jc 9kz #-.#l$n`qCu]}*jj mwNWu^KkG YZp{ k r  3!8""^"F".h"#T$sK$ 8'Q'{').*q*&*1+3+X+?,u&,R,"*.Z@.S.RV.^c.~0 Y1& 23t3333N45J5/ 6c6 x6478}9 :=4:[d:w:;<<S9<&=f==U={=>M'?]?_?Is?x?}.AzAIjBmBkCEgE GFIjJ oJKLLlLMV M_MyMN NMiN aOAPvP QUR JRES9wSU%UV8VWW5W:Wa[WGX%Y(YAYl5Z>Z2 [6T\.*]X]Cz]fQ^y^n`<`#a?a'8bWbYbHc Wcec]fgGPg(i9;jVzjk krHkbk*?mNmVnnoot6p|pmBq-Kqoqq rDrs; sm?sJs)tf^tgtZuAutuJvy d2 ]{ FQ1Ay u*1QVZ_spg.*BS !5}"V2Kkk2 6_e>YQ #:R{ +4yi,G~:TwPj:W_d*w&DD[(S"u\>Xh77RLBgq8AWC D1s} A7kl^K7X&jtz$JT Tsv,WbE]%[2I=K*q5?w\OzYMhgsgi@4j@@@@UnknownG*Ax Times New Roman5Symbol3. *Cx Arial7.@Calibri5. .[`)Tahoma;Wingdings?= *Cx Courier NewA$BCambria Math"1hh$@$$gE , ,!x24[[ 3qHX ?& 22!xx This form shall be completed for any person having a need and a right to access Cabinet for Health & Family Services data through a remote terminal of the Commonwealth mainframe computer systemkathleena.collinsDeborah Hall Hendersonx                      Oh+'0Hdp     (08@This form shall be completed for any person having a need and a right to access Cabinet for Health & Family Services data through a remote terminal of the Commonwealth mainframe computer systemkathleena.collins Normal.dotmDeborah Hall Henderson5Microsoft Office Word@ޡ @PY@TZ@(w^Z12900.0000000000)0x0101002B284E600664F143B028182E417803ns:ds="http://schemas.openxmlformats.org/officeDocument/2006/customXml"/>as.microsoft.com/office/2006/metadata/longProperties"/> ?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^`abcdefijklmnxqtwuyz{|}~Root Entry F05Os 1Table/(_WordDocument8\SummaryInformation(_DocumentSummaryInformation8tCompObjrMsoDataStore05O05OUZQMEBSAFQOCA==2 05O05O # !")$&'(  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q ds:itemID="{B17D5CEB-051E-4C45-9806-C2B113CF9826}" xmlItem  PropertiesRFRUYBKEYJ==2 05O05OItem  Properties HA4AQ4Q==205O05OItem h7$Properties%gDocumentLibraryFormDocumentLibraryFormDocumentLibraryFormffice/2006/metadata/longProperties"/> This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision. xs:element name="DisplayName" type="xs:string"> xs:attribute ref="pc:SystemInstanceName">  Commonwealth of Kentucky, [ This form shall be completed for any person having a need and a right to access Cabinet for Health & Family Services data through a remote terminal of the Commonwealth mainframe computer system Titlepxt   D P \  _PID_HLINKS_NewReviewCycle xd_SignatureOrder TemplateUrl xd_ProgIDPublishingStartDate PublishingExpirationDate ContentTypeId _SourceUrl _SharedFileIndex dcbsdccdoctypeA pmailto:portal.access@ky.govpmailto:portal.access@ky.gov