information security exemption request confidential · 2020. 12. 22. · 1. provide background...

STATE OF CALIFORNIA – DEPARTMENT OF GENERAL SERVICES INFORMATION SECURITY EXEMPTION REQUEST Information Security Office - Form ISO-04 REQUESTER INFORMATION DGS-ISO USE ONLY Date Information Security Officer or Designee Signature / Printed Name Department of General Services Information Security Exemption Request ISO-04 - Ver. Jan2020 Page 1 of 1 DGS Information Security Office (916) 376-3940 or [email protected] 3. Phone Number: 5. Office/Unit: EXEMPTION INFORMATION REQUESTER SIGNATURE Date Signature Please address the following information with details about the information security exemption being requested and be as detailed as possible. Upon completion, please print and sign this document and send to the Information Security Office: 707 3rd Street, 3rd Floor, West Sacramento, CA 95605. Alternatively, this form may also be printed, signed, scanned and emailed to [email protected]. Please note: This request must first be approved by the ISO prior to the implementation of this exemption. Please do not email this form directly to the Chief Information Security Officer or directly to individual Information Security staff. 1. Provide background information for this request. Cite current DGS policies/procedures that need to be circumvented for this request. 2. Identify alternatives considered and explain why said alternatives are determined not to be an appropriate course of action. 3. Explain how this exemption will solve or mitigate the current situation detailed above and include how long the exemption is needed. 4. Describe the risks involved in the implementation of this exemption. Must not be left blank or "N/A". 5. For the risks identified, please describe the action(s) which will be taken to mitigate these risks. Must not be left blank or "N/A". ☐ APPROVED ☐ APPROVED WITH CONDITIONS ☐ DENIED ISO Comments: 1. Requester Name: 2. Job Title: 4. Division: 6. Short Description of Exemption Request: CONFIDENTIAL APPROVING MANAGER, OFFICE CHIEF OR DEPUTY DIRECTOR Date Signature and PRINTED NAME Expiration / ISO Review Date: Tracking ID#: (ISO Use Only) ______________

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Page 1: INFORMATION SECURITY EXEMPTION REQUEST CONFIDENTIAL · 2020. 12. 22. · 1. Provide background information for this request. Cite current DGS policies/procedures that need to be circumvented

STATE OF CALIFORNIA – DEPARTMENT OF GENERAL SERVICES INFORMATION SECURITY EXEMPTION REQUESTInformation Security Office - Form ISO-04

REQUESTER INFORMATION

DGS-ISO USE ONLY

Date Information Security Officer or Designee Signature / Printed Name

Department of General Services Information Security Exemption Request

ISO-04 - Ver. Jan2020 Page 1 of 1

DGS Information Security Office(916) 376-3940 or [email protected]

3. Phone Number:

5. Office/Unit:

EXEMPTION INFORMATION

REQUESTER SIGNATURE Date Signature

Please address the following information with details about the information security exemption being requested and be as detailed as possible. Upon completion, please print and sign this document and send to the Information Security Office: 707 3rd Street, 3rd Floor, West Sacramento, CA 95605. Alternatively, this form may also be printed, signed, scanned and emailed to [email protected]. Please note: This request must first be approved by the ISO prior to the implementation of this exemption. Please do not email this form directly to the Chief Information Security Officer or directly to individual Information Security staff.

1. Provide background information for this request. Cite current DGS policies/procedures that need to be circumvented for this request.

2. Identify alternatives considered and explain why said alternatives are determined not to be an appropriate course of action.

3. Explain how this exemption will solve or mitigate the current situation detailed above and include how long the exemption is needed.

4. Describe the risks involved in the implementation of this exemption. Must not be left blank or "N/A".

5. For the risks identified, please describe the action(s) which will be taken to mitigate these risks. Must not be left blank or "N/A".

☐ APPROVED ☐ APPROVED WITH CONDITIONS ☐ DENIEDISO Comments:

1. Requester Name: 2. Job Title:

4. Division:

6. Short Description of Exemption Request:

CONFIDENTIAL

APPROVING MANAGER, OFFICE CHIEF OR DEPUTY DIRECTORDate Signature and PRINTED NAME

Expiration / ISO Review Date: