Access Indiana Client Set-up Request

Agency Name

First Name

Last Name

Email Address

Phone

Agency Security Coordinator Name

Agency Security Coordinator Email Address

Agency Security Coordinator Phone Number

Application Name

This name is visible to the user

Application URL:

Application outside the State Network?

If your application is outside the State network, you may need to provide additional firewall information

Are Cookies used for Authentication?

If your application does not utilize cookies, you may need to provide additional information

Would you like to set-up a localhost Client ID?

Development URLs

URL for Application DEV Environment

URL for Application QA Environment

URL for Application UAT Environment

URL for Application Integration Environment

URL for Application PROD Environment

Agency Return URL

The URL that Access Indiana will return the user to once authenticated

Re-direct URIs

Agency Initiated Sign-In

Front channel path over which users are directed once authorized from Agency

Agency Initiated Application sign-out Re-direct

Front channel path over which users are directed after sign-out from Agency

Access Indiana Application sign-out Re-direct

Back channel path over which users are directed after sign-out from Access Indiana

Additional URIs: (if applicable)

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