State Form 38395 - Information Processing Policy And Management Procedures

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State of Indiana - Information Processing Policy
Project Change
Step 5
And Management Procedures
Request
Page 1 of 1
A. Requesting Authority:
B. Division or Group:
C. System Name:
D. Description of Change Request (
One Time Special, or
Permanent):
E. Reason for Request:
F. Estimate of Costs to Implement Change:
One-Time
Annual
1. Agency Costs
•
Personnel
•
Equipment & Software
•
Contract Services
•
Miscellaneous
•
Total Agency Costs
2. Information Services Division Costs
•
Development and Programming Services
•
Processing Services
•
Dedicated Facilities
•
Total Info. Services Division Costs
3. Total Costs
G. Requested By:
H. Change Request No.
Name
Date
Agency Acct No.
I. Approved By:
Agency Head:
Budget Analyst*:
(* If Required)
Name
Date
J. Implementation Control
Activity
Completed By
Date
Detail Design
Design Acceptance (User)
Testing
Test Acceptance (User)
Reference Material Updated
Production Catalog
Production Run
Production User Acceptance
K. Change Request Close Out:
Date
Name
State Form #38395

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