INSTRUCTIONS: Use the section that best matches your security request. Requestor should Cigna.SecurityManagement@acs-inc.

com for any assistance in completing this form. There are two parts in this form: PeopleSoft Access: A. New or Update User Profile B. Create/Update Role(s)/Permission List(s) C. Query Access to Records D. Security by Department Tree E. Security by Permission List F. Miscellaneous Non-PS Access: A. Database B. Unix C. Miscellaneous Naming convention is <emplid/winid/cid/multiple users>_Security_Request_Form_<YYYYMMDD>.doc Only one user per form (multiple users require multiple forms)

contact

CIGNA User: CIGNA security SME completes the CIGNA ACS Security Request Form and submits to ACS Security shared mailbox (Cigna.SecurityManagement@acs-inc.com) ACS User: For existing users, requestor completes the CIGNA ACS Security Request Form and submits to their respective manager. Manager should validate and approves by forwarding it to ACS Security shared mailbox (Cigna.SecurityManagement@acs-inc.com)

CIGNA Security Form v1.1 Date Amended 13 JAN 2012

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A. New or Update User Profile (PEOPLESOFT ACCESS) Last Name, First Name: EE ID/Consultant PIN/Operator ID: Action (New/Update Access/Disable Access) Environment (Prod, SIT, QAT, PLT, P2T DVD etc): E-mail (For POI's only): RBAC/ACS Roles (add): Please refer the Role Matrix below for the appropriate Roles. RBAC/ACS Roles (remove): Row Level Sec. Permission List: Row Level Sec. Departments (add): Row Level Sec. Departments (remove): Data Permission Roles (add) Data Permission Roles (Remove) Other Access (Specify) Note: To request same access to multiple users please update the attached spreadsheet along with this form. To select functional Roles please use Roles/Permissions spreadsheet below. SINGH, HARIKESH 40829974 New Prod,SIT,QAT,PLT,P2T harikesh.singh@xerox.com CG_ACS_HRIS_ADMIN

Read/Write

No Access

Cigna Security Form Multiple Users.xls

Roles/Permissions list

CIGNA Security Form v1.1 Date Amended 13 JAN 2012

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Create/Update Role(s)/Permission List(s) For new or customized pages that needs be granted to CIGNA/ACS users: CIGNA security SME approves by forwarding the form to ACS Security shared mailbox (Cigna.SecurityManagement@acs-inc.com) requesting a SC ticket be created for the security request RBAC/ACS Role (if known) Permission (if known) Environment (Prod, SIT, QAT, PLT, P2T, DVD etc) Navigation (e.g. Root > Workforce Admin > etc) Menu Component Page Access Type (None, Display Only, Add, Update Display, Update Display All, Correction) Note: Choose None to remove access Other Instructions B. Query Access to Records RBAC/ACS Role (if known) Permission List (if known) Access Group (if known) Environment (Prod, SIT, QAT, PLT, P2T, DVD etc) Records (add): Records (remove): Other Instructions C. Security by Department Tree RBAC/ACS Roles (if known) Row Level Sec. Permission List (if known) Environment (Prod, SIT, QAT, PLT, P2T DVD etc) Row Level Sec. Departments (add) Row Level Sec. Departments (remove) Other Instructions

Read/Write

No Access

CIGNA Security Form v1.1 Date Amended 13 JAN 2012

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D. Security by Permission List (Data Permissions) RBAC/ACS Roles (if known) Data Permission List: Environment (Prod, SIT, QAT, PLT, P2T DVD etc) Security Set Security Type Other Instructions Values to be used for Security Type and Key 1 Security Access Type Key 1 Use 005 for Reg Region 3 character Reg Region code Use 101 for Emplid ManagerID for whom you need to provide access E. Miscellaneous (Including access to Component Interfaces, Web Services etc) RBAC Role (if known) Permission List (if known) Environment (Prod, SIT, QAT, PLT, P2T, DVD etc) Other Instructions

Security Access Type

Key 1

CIGNA Security Form v1.1 Date Amended 13 JAN 2012

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Please contact Security/Access Management Team for any questions or problem with the AMF or with the Account Administration Process. Email Address: Cigna.SecurityManagement@acs-inc.com Upon completion of this form, attach managers email approval together with this form and email to Security/Access Management Team Cigna.SecurityManagement@acs-inc.com

Account Owner (*Field compulsory to fill in)NON-PEOPLESOFT ACCESS Action * Company * First Name * Job Title * Phone No Managers Name * WIN ID *
For ACS Employee Only

New ACS

Harikesh Systems Development Consulatnt

Last Name * Email * Location * Managers Email *

Singh harikesh.singh@xerox.com Little Falls, NJ

Select One Option

40829974

Database Account Request Type User Name Environment Name(s) All access granted will be read only access unless otherwise specified in Other Access below. Other Access * * only required if access modification is needed : Select One Option

Request Type

CGP91DVD CGP91QAT CGP91SIT CGP91PLT GGP91P2T CGP91PDP

CIGNA Security Form v1.1 Date Amended 13 JAN 2012

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UNIX Account Request Type User Name Please select appropriate Checkbox as applicable Developer Support Tester Other Access (Specify Business Reason)

Request Type

* only required if access modification is needed

CIGPITLINVMPSFAP101 (10.204.15.72) - CGP91DVD ,CGP91SIT CIGPITLINVMPSFAP201 (10.204.15.71):CIGH91QAT CIGPITLINVMPSFAP701 (10.204.15.70):CGP91PLT,CGP91P2T

Miscellaneous Accounts Request Type Request Type Account Type CITRIX User Name Citrix non-Prod Server Citrix Prod Server

40829974
Request Type Request Type Request Type Request Type Request Type Remarks: AMERICAS DOMAIN CIGNA SHAREPOINT HPQC Kforce ODM * only required if access modification is needed Americas Domain Access is required if you have requested access to Citrix Site: https://sp.acs-inc.com/ess/projects/hcms/hcmsprj1/default.aspx Select One Option

CIGNA Security Form v1.1 Date Amended 13 JAN 2012

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Management Approval

1st level of Approval:

Manager Name Date
(dd-mm-yyyy)

Balaji Seshadri 05/18/2012

Manager Email

Balaji.Seshadri@xerox.com

2nd level of Approval (is required for all production environment access):
* Manager Name Date
(dd-mm-yyyy)

Barbara Defeo 05/18/2012

Manager Email

Barbara.Defeo@cigna.com

PS: There is no need of first level approver if a request comes from 2nd level of approver directly Approval Matrix 1st level of Approvers Department CIGNA ACS HRIS Team ACS Payroll ACS ESC/WFA Approvers John Kissel/Barbara Defeo/Julie Bower Anthony Ngu/Balaji Seshadri Joan Thompson Victoria Stevens

2nd level of Approvers Production

Barbara Defeo/Julie Bower

CIGNA Security Form v1.1 Date Amended 13 JAN 2012

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