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Policy Instrument Exception Request

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					                         STATE OF MONTANA
                DEPARTMENT OF ADMINISTRATION
                                                                                              Brian Schweitzer
          INFORMATION TECHNOLOGY SERVICES DIVISION                                            Governor




Policy Instrument Exception Request
Use this form to request an exception from compliance to information systems
policies or standards.

This form initiates the compliance exception process for information systems (IS) policies,
standards, procedures, and other policy instruments.

To request an exception to a policy instrument, send this completed form to Policy Manager at
ITSD Service Desk (at http://servicedesk.mt.gov/ess.do), or call (406) 444-2000.

For questions related to this form, contact the Policy Manager at itpolicy@mt.gov.

Complete the following:

              Subject:    <Enter the subject of the exception.>

             Contact:     <Contact Name for this request>

        Organization:     <Requesting Organization>

  Contact Information:    <Telephone and/or email>

  Date (or Timeframe)     <Date>
              Needed:




Continued on next page.




                                               Page 1
POLICY     INSTRUMENT         EXCEPTION         REQUEST
PAGE 2


Please provide the following information. The information may be refined throughout the
process.

   1. Exception From Requirement: Which requirement of what policy, standard, rule,
      procedure, specification, etc. is the subject of this request?

   <Enter text here.>

   2. Business Requirement(s): Identify the requesting organization’s affected business
      requirement(s) and how the requested exception affects the business requirement(s).

   <Enter text here.>

   3. Rationale of the Exception: Provide a business description and rationale of the
      requested exception.

   <Enter text here.>

   4. Impact: What is the impact to the organization and the enterprise, if the exception is
      granted and if not granted? (Strategic, operational, tactical, financial, etc.)

   <Enter text here.>

   5. Other Considerations: Describe any other impact or considerations pertinent to the
      decision to approve an exception.

   <Enter text here.>




                        --- END OF REQUEST ---




Version 2.2.5 - 3/10/2009                                                                 Page 2
POLICY     INSTRUMENT          EXCEPTION         REQUEST
PAGE 3


                     --- CIO STAFF SECTION ---

This section to be completed by the CIO Staff.


RECOMMENDATION




CIO    APPROVAL


   APPROVED                           DISAPPROVED          SEE ME




                         Signature                          Date




Version 2.2.5 - 3/10/2009                                           Page 3

				
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