PCMS CHANGE REQUEST FORM - Download as DOC - DOC by zPI7RLT

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									                                       CORPORATE SYSTEMS CHANGE REQUEST (CR)
SECTION I: INFORMATION TO BE PROVIDED BY CONFIGURATION MANAGEMENT OFFICER
1. CR #:                  2. Date Request Received:         3. Date Assigned:

4. CR Status: ____ Active ____ Inactive                                           5. Date Completed:

SECTION II: INFORMATION TO BE PROVIDED BY CR ORIGINATOR
6. Name                                         7. Phone Number/E-mail Address:                   8. Organization:             9. Date Created:

10. Primary System Impacted:                                        11. Critical Implementation Date:

12. Title:

13. Description of Problem:

14. Benefit and/or Justification: (Detailed Cost Savings, # of Transactions Saved, # of FTEs Saved, Cycle Time Reduction, Legislation or Legal
Reference for Mandated Changes):

15. Current or Potential Workaround:


16. Impact if Not Approved:


17. Service Request # (Required)        18. Category:
and Associated CR # (Optional):          ____ BW / FDW             ____ Technical Configuration Change         ____ System Modification
                                         ____ Security Role        ____ Functional Configuration Change

19. Priority:      ____ Routine   ____ Urgent     ____ Mandated ____ Emergency (If Emergency, describe immediate hardship)

SECTION III: INFORMATION TO BE PROVIDED BY THE TECHNICAL LEAD/DEVELOPMENT MANAGER
20. Technical Lead / Development Manager:              21. Date:                                             22. Phone No.:

23. Person Assigned:                                   24. Requirements Analyst:                             25. System Version/Release:

26. Impact Statement (Note any/all system downtime):

27. Configurable Items (CIs) Affected/Dependencies:


28. Organizational Impact:        _____ Department Wide       _____ Agency Specific
29. Requested Change: _____ Requirement           _____ Enhancement
30. Level of Effort/Time Estimate:                                         31. Projected Start Date:           32. Projected End Date:


SECTION IV: ENGINEERING REVIEW BOARD (ERB) RECOMMENDATION (if applicable)
33. Disposition:      ____Approved      ____Conditionally Approved        _____ Deferred       ____Disapproved           ____Withdrawn
34. ERB or Technical Comments:



35. Authorizing Signature:                                                                                           Date:

SECTION V: FINAL RECOMMENDATION BY APPROVING AUTHORITY
36. Disposition:      ____Approved      ____Conditionally Approved        _____ Deferred       ____Disapproved           ____Withdrawn
37. Target Release:          38. Release/Implementation Date:           39. Approved Priority:
                                                                        ____Routine    ____ Urgent        ____Mandated       ____Emergency
40. Comments:


41. Approval Authority
    ____ COD Associate Director Reporting and Administration              ____ Associate Chief Financial Officer for Financial Systems
    ____ Corporate Mixed Systems Division Director
    ____ Security Program Manager                                         ____ Configuration Control Board

42. Approval Signature(s)                                                                                            Date:

                                                                                                                  Revised Form AD1168 (08/06/10)
CORPORATE SYSTEMS CHANGE REQUEST (CR)




                                        Revised Form AD1168 (08/06/10)

								
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