DUO Security Hardware Token Sign-out Sheet

By submitting below, I acknowledge the following:

  1. Duo Security hardware tokens are used for employees to authenticate to the two-factor system for VPN access when no other methods are viable.
  2. Each hardware token is a controlled device. Employees must secure them in the same manner as they would a state-owned key.
  3. Lost, stolen, damaged or missing tokens must be reported by calling the EITS Helpdesk at (775) 684-4333 and you must also inform NHP R&P via your chain of command. 

  4. Upon termination of my VPN Account, I will return the hardware token to my Regional Administrative Lieutenant. Failure to do so may result in criminal or civil action against me.
  5. Cost for replacement tokens will be charged to my agency or sponsoring agency (if a contractor entity).
  6. By submitting below, I acknowledge receipt of one (1) Duo hardware token, DSEC # as indicated on the DSEC# line below.
  7. Make sure the form is filled out 100% and all information is accurate.

DSEC No.:    

Name (First and Last): 

Contact Phone No.:   

Email Address:

Desktop Login Username (nvdps\xxxx):   

Sponsoring Agency Name: 

Region:   

Which phone do you want to use for DUO Authentication? 

Phone Used For DUO:    Device Phone No.:   

Phone Operating System (i.e., Android, iOS, etc.): 

What is your State MDC tablet ID number? 

MDC Tablet ID No. (Example: 350126): 

By providing your employee ID number below, you acknowledge/verify the information above is correct: 

State Employee ID No.: