Technical Assistance Request Form

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MeCare Technical Assistance Request Form

Note: If you have any problems using this form, you may email your request or comment:

Name:

Date:

Time:

E-mail Address:
Please include your e-mail address if you want us to respond back to you.

Category:
Error Message
Incorrect Action
Eligibility Calculation
Dial-up

Wrong Data Displayed
System Crash
Printing
Other

Which screen was active at the time of the error:

Which database were you on?
Production Training

ID:

Status:

Version:

Owner:

Short Description of Problem:

What steps did you take to produce the problem:

Describe the problem and what happened:

Additional Comments:

Shiva

Use this section to enter problems related to dialing in the the State of Maine's WAN using IPRS or SecureRemote

SecureRemote IPRS

Date and time problem was experienced: AM PM
First three digits of the number you were calling from:

Please check below those that apply:
Busy signal: Yes No
Passcode Accepted: Yes No
Disconnected after successfully connected: Yes No
Passcode accepted but unable to connect to server: Yes No

Please indicate what number you were calling below:

Toll-free - IPRS (Verizon) 1-500-699-1800

Toll-free - IPRS (non-Verizon) 1-800-734-7564

Shiva Comments:

Revised: 3/13/2007