EvaluationWeb: Add/Edit Account Form
Request to Add/Edit Account in Minnesota EvaluationWeb
INSTRUCTIONS: This form is to be completed by the user and forwarded to your supervisor for review, approval and signature.
Once the form is completed, forward the original signed form to the Minnesota Department of Health’s (MDH)
EvaluationWeb Coordinator for approval. Keep a copy of this form on file at your agency. If the request is denied, the
EvaluationWeb Coordinator will communicate the rationale to your supervisor. Please allow seven to ten business days to
complete your request.
For New Accounts: All persons requesting access to EvaluationWeb must be e-authenticated, or identity proofed, via the
CDC SAMS system. Instructions for the process can be found at http://www.health.state.mn.us/evalweb . Please note:
Acceptable identity documents include government-issued photo ID cards that have an ID number (i.e., state-issued
driver's license, military ID, or passport).
If you’ve been waiting for more than ten business days and have not been contacted by SAMS, contact their help desk at
samshelp@cdc.gov or 1-877-681-2901. If you continue to have difficulty, submit an EvaluationWeb help ticket at
http://www.health.state.mn.us/evalweb . Once identity proofing is complete, Luther Consulting will provide instructions
for accessing EvaluationWeb.
Mail request to:
Add New Account
Edit Existing Account
Or Fax request to:
Minnesota Department of Health
STD and HIV Section – Attn: Tina Klein
625 Robert Street North, P.O. Box 64975
St. Paul, Minnesota 55164-0975
Confidential Fax: 651-201-4040
Date Requested:
Agency Name:
Requestor’s Full Legal Name:
Requestor’s Job Title:
Requestor’s Signature:
Requestor’s Phone:
Requestor’s E-Mail:
1st Security Question:
What is the name of your high school?
2nd Security Question:
What is your mother’s legal first name?
Supervisor’s Name:
Supervisor’s Signature:
Supervisor’s Phone:
Continue to Page 2 to select the user’s permissions.
Submit your signed EvaluationWeb User Agreement along with this form for new accounts only.
Please maintain a copy of this form and the signed User Agreement on file at your agency.
EvaluationWeb Add/Edit Account Form – V.2
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EvaluationWeb: Add/Edit Account Form
GRANTEE STAFF:
There are two types of permissions available to HIV prevention grantees, as described below. A user may have one or both
of these permissions assigned, based on their current job responsibilities.
To add a new account, select, “Add this permission,” under HIV Testing and/or Prevention with Positives, as appropriate
to the users job responsibilities.
To edit existing accounts, check the appropriate box under HIV Testing and the appropriate box under Prevention with
Positives to indicate the permission(s) the user should now have.
HIV Testing – HIV Testing staff and supervisors have the ability to view, enter, and edit HIV testing data, Condom
Distribution data, and to run and create reports for their agency. (MDH Use: User Level 6 – Data Entry with Reporting)
HIV Testing and Condom Distribution
Add this permission
Remove this permission
Maintain this permission
Prevention with Positives – Prevention with Positives staff and supervisors have the ability to view, enter, and edit
client-level risk reduction intervention data, Condom Distribution data, and to run and create reports for their agency.
(MDH Use: User Level 6 – Data Entry with Reporting)
ILI and Condom Distribution
Add this permission
Remove this permission
Maintain this permission
GLI and Condom Distribution
Add this permission
Remove this permission
Maintain this permission
IRRC and Condom Distribution
Add this permission
Remove this permission
Maintain this permission
PCM and Condom Distribution
Add this permission
Remove this permission
Maintain this permission
MDH STAFF:
The EvaluationWeb Coordinator will assign the appropriate permission for you.
MDH HIV Prevention Contract Manager – MDH HIV Prevention contract managers have the ability to view HIV testing
and risk reduction intervention data and to run, create and save reports for all funded agencies for the purpose of
monitoring performance. (MDH Use: User Level 8 – Jurisdiction)
MDH Administrator – MDH Administrators have the ability to view, enter and edit HIV testing and risk reduction
intervention data for all funded agencies. They are able to run, create and save reports for all funded agencies. In
addition, MDH Administrators are able to unlock records, send out jurisdiction-wide messages, set jurisdiction-wide
variables, edit basic user information, add Level 1 users (workers), upload XML data to the system, switch between
data upload and direct data entry, and run reports related to XML upload and quality assurance. MDH Administrators
can add, edit and tag delete agencies, programs and interventions for the jurisdiction. This is the highest level of
clearance possible at the health department level. (MDH Use: User Level 9 – Administrator with Data Transfer Reporting)
MDH Internal Use Only:
EvaluationWeb Data Project Coordinator:
Approved
Denied
Effective Date:
Forward to EvaluationWeb Administrator for Implementation:
Username:
Effective Date:
System Access Completion:
Effective Date:
EvaluationWeb Add/Edit Account Form – V.2
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6/28/2016