NCSBI - Agency Contact Information

CIIS Forms > Agency Contact Information

Agency Contact Information

Please update the information for your Agency. All contact information is encouraged and required fields are indicated in blue.

Agency Authorized Personnel defined:

Agency Authorized Personnel (AP)

Authorized Personnel is agency personnel authorized to receive, view, handle, disseminate (within the agency), store, retrieve, or dispose of CJI/CHRI. ALL Authorized Personnel must sign a Regulation Regarding Receipt of CHRI form. NCSBI Best Practice Policy

Authorized Personnel List (APL)

The Authorized Personnel List contains all agency personnel who are authorized to receive, view, handle, disseminate, store, retrieve, or dispose of CJI/CHRI. The Authorized Personnel List should contain the names and titles of the agency’s authorized individuals. NCSBI Best Practice Policy

Agency Point of Contact (POC)

The Point of Contact (POC) is the primary liaison between the user agency’s Access Agreement and the NCSBI. The POC is responsible for receiving the CHRI results and keeping the results confidential and secure and stored separately from personnel files. The POC is responsible for billing invoices and updating the agency’s CHRI result mailing address and Authorized Personnel list

Criminal Justice or Non Criminal Justice Agency:

Agency Name:

Account Number (OCA/ORI):

Agency Type:

If you are a healthcare provider, provide your license #:

Agency Point of Contact (POC) Name:

(POC) Email Address:

(POC) Phone:

()-

(POC) Fax:

()-

Audit Contact:

Audit Contact Contact Email:

Audit Contact Contact Phone:

()-

CJIS Online Administrator Name:

CJIS Online Administrator Email:

CJIS Online Administrator Phone:

()-

Billing Point of Contact Name:

Billing Point of Contact Email Address:

Billing Point of Contact Phone:

()-

Street 1:

Street 2:

Street 3:

City:

State:

Zip Code:

NEW Authorized Personnel Name 1 :

Email Address:

Add a second Authorized Personnel?:

NoYes

Add a third Authorized Personnel?:

NoYes

Remove the following Authorized Personnel:

Comments:

Answer the question below:

Is 7 = 6 ? (true/false)

Agency Authorized Personnel defined:

Investigations

Director Bob Schurmeier

Services