eDSRS Registration

Required Fields

Completion of this form is required in order to receive appropriate system access to the Illinois Department of Human Services DUI Service Reporting System (eDSRS) application. The email address submitted will become the User ID for the individual and information entered on this page.

Note: If you are an existing user, select ALL responsibilities performed within your Agency. Although you may have been approved for a specific responsibility in a previous Registration request, this Registration request will take precedence over previously approved Registrations!

Worker Information

Email Address:

Re-Type Email Address:

Last Name:

First Name:

Middle Initial:

Organization:

I am responsible for the overall operations (Organization Representative)
I am responsible for the daily business operations (Organization Administration)
I am responsible for the financial aspect and bill submissions (Organization Fiscal Operations)
I am responsible for entering Evaluation and/or Risk Education information (Organization Entrant) Appropriate credential(s) must be entered.

Credentials	Expiration Date (mm/dd/yyyy)
Certified Advanced Alcohol & Other Drug Abuse Counselor (CAADC)
Certified Alcohol & Drug Counselor (CADC)
Certified Alcohol, Tobacco & Other Drug Abuse Preventionist (CADP) - Risk Ed Only
Certified Assessment & Referral Specialist (CARS)
Certified Reciprocal Alcohol & Other Drug Abuse Counselor (CRADC)
Certified Senior Alcohol, Tobacco & Other Drug Abuse Preventionist (CSADP) - Risk Ed Only
Certified Supervisor Alcohol & Other Drug Abuse Counselor (CSADC)
Doctor of Medicine (MD)
Doctor of Osteopathy (DO)
Licensed Clinical Professional Counselor (LCPC)
Licensed Clinical Psychologist (LCP)
Licensed Clinical Social Worker (LCSW)
Licensed Professional Counselor (LPC)
Licensed Social Worker (LSW)

eDSRS Registration

DUI Registration