Section 508 Compliance Report Request Form
Requestor Contact Information:
Request Date:	Select from Calendar Picker	Scan Due Date:	Select from Calendar Picker
Time Reporting Account Code:	Enter Text	DEA Unit Name:	Select from Drop-Down
Requestor's Name:	Enter Text	Supervisor’s Name:	Enter Text
Requestor’s Email Address:	Enter Text	Supervisor’s Email Address:	Enter Text
Requestor’s Phone Number:	999.999.9999	Supervisor’s Phone Number:	999.999.9999
Environment:
Current Environment:	Select from Drop-Down	Release Number:	Enter Text
Migration Environment:	Select from Drop-Down	Migration Date:	Select from Calendar Picker
Site Technologies Used – Please check all that apply:
SiteMinder:	☐	Google Tag Manager / Analytics:	☐
JavaScript:	☐	AJAX:	☐
Dynamic HTML:	☐	Cookies:	☐
Session State:	☐	Forms Based Authentication:	☐
Scan Details:
Test User ID:	Enter Text	Test Password:	Password#1
System Name:	Enter Text	System Acronym:	Enter Text
Website’s URL:	Enter Text	Web Server Name:	Enter Text
Site Map & Screen Processing Information:
Site Map - List of screens to be tested or ALL screens within system:
Screen Processing Information - Special Instructions and Notes to Tester: