I. Person Filling Out Application (Required)

The purpose of these questions is to identify the IP addresses that the EPA internet server will "see" if a user browses one of the OTIS web pages. For example, the IP address of the computer you are currently using appears to this server as: 38.103.63.16.

IIa. Firewall(s)/Proxy Server(s) in Use

Q1. Do you have a single firewall/proxy server that covers your entire organization? If so, please list the IP address of the firewall/proxy server below. (This address should reflect the IP address "seen" by the outside world whenever a user inside the firewall browses the Internet.)

1a. IP Address: ... (e.g., 223.131.12.68)

Q2. If you do NOT have a firewall/proxy server that covers your entire organization, do you have several firewalls/proxy servers for different organizational units that would like to apply for access? If so, please list the IP address of each firewall/proxy server and the name of the sub-organizations protected by each firewall/proxy server.

2a. IP Address: ... Sub Org:
2b. IP Address: ... Sub Org:
2c. IP Address: ... Sub Org:
2d. IP Address: ... Sub Org:

Add more if needed:

Comments:

IIb. Firewall(s)/Proxy Server(s) NOT in Use:

Q3. Does your organization use blocks of static IP addresses? If so, please list the range of IP addresses and the name of the organization or sub-organization associated with each range.

3a. IP Address: ... to  ...
Organization (or Sub Org.):
3b. IP Address: ... to ...
Organization (or Sub Org.):

Add more if needed:

Q4. If your organization does not use static IP addresses, please list the part of the IP address that all dynamically assigned IP addresses have in common (shared domain). Please repeat your answers for each sub-organization that may be interested in access to OTIS.

4a. Shared Domain: ...xxx
Organization (or Sub Org.):
Do you share this "domain" with agencies that are not part of the organization/state? Yes No

4b. Shared Domain: ...xxx
Organization (or Sub Org.):
Do you share this "domain" with agencies that are not part of the organization/state? Yes No