Form 38421 - Information Processing

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State of Indiana - Information Processing
Request for
Step 1
Policy and Management Procedure
Project Proposal
Page 1 of 1
A. Requesting Agency:
B. Division or Group
C. Project Name:
D. Description of Problem or Opportunity:
E. Potential Significance, Savings, Benefits and Costs:
F. Implementation Plan:
Activity
Responsibility
Desired Completion Date
Prepare Step 2
Implement System
G. Estimated Resources Required for Preparation of Step 2:
1. Requesting Agency Personnel
$____________ (_____ Person Days)
2. Information Services Division
$____________ (_____ Person Days)
3. State Incremental Costs
$____________
4. Total Cost of Step 2
$____________
5. (Check all Applicable – Requires an Attachment and Budget Agency Approval)
Additional Budget Request
Additional Personnel Request
Non-State Funds to be Used
State Match Required
H. Requested By:
J. Agency Project Control:
NAME:
Date:
Agency Project Number
Agency Account Number
Agency Project Manager
I: Approved By:
Date:
Agency Head
Date Assigned
Budget Analyst*
Date:
State Form #38421

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