Telecommunications Data/Intercity Service Request (TDR)

Telecommunications Intercity / Data Service Request (TDR)

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

Note: These instructions will lead you through the (TDR) Form box by box.

1. Enter today’s date and the date requested for service to be operational. Required

2. Identify agency, the coordinator in charge of the project, his/her address, phone and fax number, and e-mail address. The person identified in this box will receive all notifications about this order. Required

3. Identify agency, the coordinator in charge of the project, his/her address, phone and fax number, and e-mail address. The person identified in this box will receive all notifications about this order. Required

4. The person signing the TDR must have signature authority. Required if mailed or faxed. (E-mail address serves as electronic signature if submitted via email.) Complete date field and print the name under the signature.

5. The PRIMARY STATION identifies circuit location. Provide site contact information, including address, floor and room number, site hours, phone, fax, and mark appropriate box indicating whether building is new or remodeled. If an outside move is requested, list the existing station information in this section with the 'move to' address information in section #9.

6. CMS Telecom use only

7. CMS Telecom use only

8. Use this box for any additional comments or special instructions.

9. The Secondary Station Box specifies the location where service is to be terminated. Please include service address, floor and room number, site contact, site phone number, and site hours. Mark appropriate box to indicate building is new or remodeled. Provide any special AU billing information. If requesting the addition of a station to an existing circuit, use Section # 9 and submit only page #1 for processing.

General Instructions

Attach additional copies of the TDR form as needed. Number accordingly in top right-hand corner.

In the upper right quadrant of pages 1 and 2, is a non-shaded, double-lined box. The file # refers to the circuit name under which CMS will file this order. If you are requesting service to be performed on an existing circuit, please fill in the circuit number in the space provided.

In an effort to streamline the TDR process, we have posted the new TDR on the BCCS web page ( www.bccs.illinois.gov - click on Telecom Services). The form is a WORD2000 template allowing you to TAB from field to field.

We suggest that you download the TDR and save it to your hard drive. As you use this form, you will be able to save a copy of each order. The authorized agency Telecommunications Coordinator can transmit the TDR as an email attachment with his/her email address serving as an electronic signature. Please put your agency control [tracking] number in the subject line of your e-mail.

Submit TDR to:
Electronic/email: cms.prov@Illinois.gov

Customer Solution Center
Attn: Provisioning
120 West Jefferson St., 2nd Floor
Springfield, IL 62702-5103
FAX number: (217) 524-5895 (Emergency orders ONLY with prior approval.)

Questions: contact the Customer Solution Center
800-366-8768 [in Springfield at (217) 524-4784]