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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


     Indian Health Manual
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Part 8, Chapter 17:  Manual Exhibit 8-17-A

Cellular Telephone and BlackBerry® Smartphone
Justification and User Agreement


The Indian Health Service (IHS) is responsible for issuing and managing IHS-issued cellular telephones, BlackBerry® Smartphones, and personal digital assistant (PDA) devices and their associated service plans.  This form must be completed before an employee is authorized to receive an Agency-issued cellular telephone, BlackBerry® Smartphone, or PDA device.

This form must also be completed and signed (by the user and the first and second level supervisors) on an annual basis on May 15 (or the next business day) and provided to the first line supervisor and designated IHS Ordering Official.  Failure to do so will result in the deactivation of the cellular telephone, BlackBerry® smartphone, or PDA device.

Instructions:

  1. Complete this form; sign and date it before requesting an Agency-issued cellular telephone, BlackBerry® smartphone, or PDA device.

  2. Submit this form to your first level supervisor.

The first level supervisor will retain the original signed copy of the “Cellular Telephone and BlackBerry® Smartphone Justification and User Agreement,” in the employee’s personal administrative file as long as the user retains the device.


PART 1 - Account Holder Identification

Account Holder's Name:
Unit/Dept:
Office Phone: (____)

PART 2 - Requirement/Justification/Approval

Request is for:

Cellular Telephone___ BlackBerry® smartphone____ PDA____

Justification including the business need for the request and explanation as to why other options are not practical:_________________________________________________________

Approved____ Disapproved____

First Level Supervisor:___________________________________ Date:_________________

Approved____ Disapproved____

Second Level Supervisor:__________________________________ Date:_________________

PART 3 - Service Agreement

___I agree to follow all local, State, and Federal laws regarding the use of an electronic device while using an IHS-issued cellular telephone, BlackBerry® smartphone, or Personal Digital Assistant (PDA) device.

___I understand that I may be required to reimburse the IHS for any cellular telephone or BlackBerry® service charges not authorized per this agreement, and/or deemed to be personal use that exceeds permitted usage as defined in Part 8, Chapter 17, "Agency-Issued Cellular Telephones, BlackBerry® Smartphones, and Personal Digital Assistant Devices," Indian Health Manual.

___I understand that Agency-issued Cellular Telephones, BlackBerry® smartphones and PDAs are not approved for handling sensitive information unless properly encrypted and that I must exercise discretion when using an IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device.

___There shall be no exception of privacy when using an IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device e-mail, pin-to-pin messaging, Short Message Sevices (SMS) or Multimedia Messaging Services (MMS) messaging.  All logs, data, and other files created while using an IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device are neither private, nor confidential. (Part 8, Chapter 17, IHM).

___I understand that usage of an IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device is subject to all conditions in Part 8 Chapter 17, IHM.

___I agree that I will not display any IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device password in public or attach passwords to any device.

___I understand that I must secure my IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device to help ensure that it is not lost or stolen.

___I understand that I must contact the IHS ISSO or the Area ISSO immediately, if my IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device is lost or stolen.  If immediate contact is not possible, I must contact the IHS OIT Help Desk (505-248-4371 or 888-830-7280) within 24 hours of the reported loss.

___I understand that after 6 failed login attempts, all data on my IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device is erased automatically, and the device returns to the manufacturer's default state.  I will contact the IHS OIT Help desk to arrange to have my BlackBerry® smartphone reconfigured.

___I understand that I am responsible for following any additional security regulations concerning my IHS-issued cellular telephone, BlackBerry® smartphone, or PDA device as defined in Part 8, Chapter 17, IHM and the IHS Rules of Behavior.

___I understand that I will not install or download any software, data application, or program not issued by the IHS unless I have received prior approval from the Ordering Official and my IT Security office.

User's Signature:______________________________________ Date:_________________________

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