Paging New Service Request Form (PSR)

CMS-BCCS Customer Solution Center

Paging Services

Instructions: Complete all information pertinent to type of requested service.

New Service Request Form:

Agency: Agency requesting service. Required

Control Number: The agency's internal record keeping number assigned by the Coordinator for tracking orders through the procurement process. Required

Coordinator's Name: The authorized Telecommunications Coordinator. Required

Coordinator's Telephone Number and Date: The authorized Coordinator's work phone number and the date the TSR is prepared. Required

AU No.: Accounting Unit Number of agency Required

Coverage: Select area of coverage from listed options from the PSR form.

Area Code: Select area code from listed options from the PSR form.

Equipment: Select type of equipment from listed options from the PSR form.

Options: Select any desired option(s) from the PSR form.

Remarks: Add any additional comments.

User Information: Provide current user's name.

Paging Shipping Information:

If your agency is going to pick up or return a pager:
Select the appropriate box.
Provide contact name and telephone number.

If the vendor is to pick up or deliver the pager:
Select the appropriate box.
Provide a contact name and number.

Specify address where pager is to be shipped or where vendor may pick it up.

Submit Order to:

CMS-BCCS Customer Service Center
Provisioning
120 West Jefferson - 2 nd Floor
Springfield , IL 62702
800-366-8768
[In Springfield 217-524-4784]