IVR Registration

PortData Source IVR Service Registration Form

This form is for those interested in registering for the PortData Source Interactive Voice Response (IVR), which is a free, telephone-based service.

Use of the PortData Source IVR system, including receipt of the Personal Identification Number (PIN), is strictly limited to the following:

U.S. Law Enforcement Agencies—agencies of the United States or of a State or political subdivision thereof that are empowered by law to conduct investigations of or to make arrests for violations of federal, state or local laws; and
U.S. PSAPs—entities performing Public Safety Answering Point (PSAP) functions in the performance of their official duties.

Please provide the full agency/organization name, do not use abbreviations. Please provide a street address, do not use P.O. Boxes.

Fields marked with an asterisk (*) are required.

Tracking Number

AGENCY/ORGANIZATION

Agency/Organization Name

Agency/Organization Type

FCC PSAP ID Number (required only for PSAP)

Law Enforcement Unit/Division/Post

Address 1

Address 2

City

County

State

ZIP Code

PRIMARY CONTACT

First Name

Last Name

Title

Phone Number

Alternate Phone Number

Email Address

SECONDARY CONTACT

First Name

Last Name

Title

Phone Number

Alternate Phone Number

Email Address

PINs

Please indicate number of PINs needed for your agency's use

AUTHORIZED REPRESENTATIVE

Certification

I certify that I am an authorized representative of either a U.S. Law Enforcement Agency or Public Safety Answering Point or an Authorized Support Organization that supports a PSAP and will access the IVR for official use only.

CONFIRMATION OF ELECTRONIC SIGNATURE

Name

Title

Date

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