Fillable Printable VA Form 8824i

VA Form 8824i

CAATS CONTRACTOR ACCESS REQUEST FORM

PRIVACY ACT STATEMENT: The information is solicited under authority of Title 38, United States Code and Executive Order 9397 and is necessary

to accomplish the action requested by the requester, including establishing, modifying or deleting a Network Resources Customer Account. Furnishing

the information on this form is voluntary; however, if the information is not furnished, we will be unable to take further action on your request.

1. ACTION REQUESTED (Check only one)

CREATE NEW CUSTOMER

MODIFY EXISTING CUSTOMER DELETE EXISTING CUSTOMER

2. CUSTOMER INFORMATION

A. FULL NAME (First Name, Last Name)

B. CAATS USER ID (Email Address)

C. COMPANY D. ADDRESS E. CITY/STATE/ZIP

F. TELEPHONE NUMBER (Include Area Code) G. JOB TITLE/DEPARTMENT H. VENDOR CODE (Tax Identification Number)

SECTION A

STATION ACCESS NEEDED

(List all stations you need

access to in CAATS)

OBLIGATION NUMBER/

CONTRACT NUMBER

ROLE

INITIATOR READ ONLY

All access requested above will require approval before action can be completed. Send this form electronically to your VR&E representative.

NOTE: Do not combine multiple staff in one email request.

3. SIGNATURES

REQUESTING OFFICIAL AND TITLE DATE

VR&E OFFICIAL AND TITLE DATE

CAATS APPROVING OFFICIAL AND TITLE

DATE

VA FORM

MAY 2013

8824i