Secure Information Exchange Hub (SIEH) Web Service Request

Delivering Technology that Innovates

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Complete form, print, route for signatures, scan and email completed and signed form to DTI_SIEH_Tech@state.de.us.

Producer Type:

E-Mail Address:

DDS or EIN:

Name (Last, First, MI):

Phone Number:

Agency Name:

Signature: Date:

E-Mail Address:

Name (Last, First, MI):

Phone Number:

Signature: Date:

Test Add Modify Service

See Attached

Provider Application IP Address:

Web Service Contact Information - Requester

Web Service Contact Information – Requester’s Information Security Officer

Web Service Provider Information

Description:

Rules to apply:

End Date: Date (Temp):

URL ProvidedSOAP REST WSDL Location:

WSDL or REST URL:

Production

Delete

Is this request for:

Change Type:

Access Limitations:

Service Type:

Modify Consumer IP

Delivering Technology that Innovates

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P:\BPM\Service Catalog 2016\Current Docs from SP\Supplemental Documentation\xML Firewalls - Web Services Request\Web Services Request Form 2.3.docx, DTI/AD; DTI/CPC/OCM, dmk/10/9/17

# of Messages:

Schedule Time:

Publicly Available:

Schedule Frequency:

Consumer Application Name:

Max Message Size:

Required Availability:

WSDL WSI Compliant:

Data Classification:

WSDL Document Literal:

Provider SSL: Consumer SSL:

Consumer Type:

E-Mail Address:

DDS or EIN:

Name (Last, First, MI):

Phone Number:

Agency Name:

Signature: Date:

E-Mail Address:

Name (Last, First, MI):

Phone Number:

Signature: Date:

For assistance or questions completing this form contact DTI_SIEH_Tech@state.de.us.

Web Service Consumer Contact Information

Web Service Consumer Information Security Officer's Contact Information

Secure Information Exchange Hub (SIEH) Web Service Request

Consumer Application IP Address:

So that we may provide you the best service possible, all previous versions of this form are obsolete and will not be accepted.