Fillable TIMS Web User Access Request Form (Minerals Management Service)

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TIMS Web User Access Request Form (Minerals Management Service)

On average this form takes 10 minutes to complete

The TIMS Web User Access Request Form (Minerals Management Service) form is 2 pages long and contains:

  • 2 signatures
  • 4 check-boxes
  • 30 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Minerals Management Service

BROWSE MINERALS MANAGEMENT SERVICE (VA) FORMS

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U.S. Department of the Interior
Bureau of Ocean Energy Management (BOEM)
Bureau of Safety and Environmental Enforcement (BSEE)
TIMS Web User Access Request Form
(This form must be printed on one page only, front and back)
USER INFORMATION:
New User __ Add Company for User __ Delete User ___
Name: ______ ______________________ __ ______________________________ ______
Prefix First Name MI Last Name Suffix
Title: _________________________________
Address: Employer Name: ______________________________________________
Division: _____________________________________________________
Street: ________________________________________________________
City: ___________________________________ State: ________________
ZIP: ______________ Country: _________________________________
Phone Number: __________________ Fax Number: ________________
Email: ________________________________________________
CERTIFICATION
1. I understand that using the BOEM/BSEE TIMS Web system means I will be using BOEM/BSEE
Computer Systems, Electronic Mail, Internet connections and associated equipment, software and
data. These resources are to be used for official government business only and in conjunction with
Department of the Interior and all related bureau policies. Law prohibits any other use of these
items (18 USC Section 641 Violations of the law can result in loss of system access.
2. If I am aware of a security breach (password sharing, hacking), I will immediately notify the
Enterprise IT Service Desk.
3. I will select my own password and I will NOT share my password or username with anyone. If I
no longer need access to the TIMS Web system for any reason, I will contact my company’s
administrator to expire my entitlements and to submit a new form to BOEM to delete my username
from the system.
4. I will handle sensitive data appropriately and understand that this information is not to be
exchanged, divulged or otherwise compromised in any way unless necessary for official
government business. I agree not to disclose information covered by the Privacy Act to
unauthorized personnel.
5. I have read the TIMS Web disclaimer and agree to the conditions specified in the document.
__ I consent and will adhere to the above terms and conditions.
User Signature: _________________________ Date: __________________
click to sign
signature
click to edit
Initial the appropriate authorization. Only one block must be initialed.
USER AUTHORIZATION
Please initial if user is employed by a BOEM Qualified Company.
_____ I authorize this user to have access to the company’s data based on entitlements
granted by the company’s TIMS Web administrator.
AGENT AUTHORIZATION
Please initial if user is employed by a third party company acting as an agent.
_____ I authorize this user as an agent user who has access to the company’s data based
on entitlements granted by the company’s TIMS Web administrator or by the
agent company’s TIMS Web administrator.
NEW COMPANY QUALIFICATION
Please initial if this account is being created for a new company qualification.
_____ I authorize this user to have access to submit a new company qualification for the
below companies only. Note: a BOEM Company Number will not be required in
the list below.
SURETY COMPANY AUTHORIZATION
Please initial if this account is being created for Surety company.
_____ I authorize this user to have access based on entitlements granted by the Surety
company’s TIMS Web Administrator and certify that I have Power of Attorney
rights for the Surety as shown in the attached Power of Attorney document.
List all companies that user will submit data for. These must be BOEM qualified
companies for which the representative below has BOEM signature authority or
a Surety company for which the representative is designated as having Power of
Attorney on the attached POA document.
BOEM Company Number Company Name
(Leave blank for Surety companies) (Must match that on BOEM Qualification File
or the attached Surety POA)
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
Representative Name: _________________________________________
(print)
Representative Title: _________________________________________
Representative Signature: ____________________________ Date: ___________
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signature
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TIMS Web User Access Request Form (Minerals Management Service)

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Completed 26 September 2021

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