Division of Homeland Security and Emergency Services

NEW YORK STATE

DIVISION OF HOMELAND SECURITY AND EMERGENCY SERVICES

OFFICE OF INTEROPERABLE AND EMERGENCY COMMUNICATIONS

Andrew M. Cuomo, Governor Jerome M. Hauer, Commissioner Statewide Communications Interoperability Plan (SCIP) Revision and Addition Request Form

Instructions for Use

Please complete this form to request a revision to the existing contents of the latest published SCIP, or an addition to the latest published SCIP. Any revisions or additions should address needs critical to performance of your mission that you feel should be revised in the current SCIP or are not addressed in the latest version of the SCIP.

The latest published copy of the SCIP can be found at: http://www.dhses.ny.gov/oiec/interoperability-plans/ under “Recent Documents.”

Please use one (1) form per revision or addition request. Upon completion, please deliver this form and any attachments to: Interoperability Coordinator New York State Office of Interoperable & Emergency Communications State Campus, Building 7A 1220 Washington Avenue Albany, New York 12242 518-322-4911 (phone) / 518-322-4975 (fax) [email protected]

Name of Individual or Agency: Date of Request (mm/dd/yyyy): Nature of Request: Revision

Addition

Description of Request:

SCIP Section(s) and Subsection(s) (if known): Section: Subsection:

Are You Including Attachments/Supplemental Documents? Remarks: Yes NEW YORK STATE

Andrew M. Cuomo, Governor Jerome M. Hauer, Commissioner No

Typed or Signed Signature: Date: NEW YORK STATE

Andrew M. Cuomo, Governor Jerome M. Hauer, Commissioner FOR OFFICE USE Review Implemented in Accepted? Remarks Required? SCIP? Yes  No  Yes  No  Yes  No 