Corporate Systems Change Request (Cr) Form
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1CORPORATE SYSTEMS CHANGE REQUEST (CR)
INFORMATION TO BE PROVIDED BY CONFIGURATION MANAGER (CM)
1. CR#:
2. Date Request Logged:
3. CCB Review Date:
4. CR Status: ____ Open ____ Closed
5. Date Status was revised:
INFORMATION TO BE PROVIDED BY ORIGINATOR
6. Name
7. Phone No.:
8. Organization:
9. Date Created:
11. Category:
13. Severity:
14. Change Type: (IAS)
10. Associated
12. Priority
CR#/Trouble
____ System Setup
Ticket#:
____ System Mod
____ Routine
____ Low
____ COTS
____ Data Fix
____ Urgent
____ Medium
____ Hardware
____ Deviation
____ Mandated
____ High
____ OS
____ Waiver
____ Software
____ EMERGENCY
____ Critical
____ Document
15. System:
16. Requested Implementation Date:
17. Title:
18. Description of Proposed Change:
19. Benefit and/or Justification:
20. Impact if Not Approved:
INFORMATION TO BE PROVIDED BY THE TECHNICAL LEAD
21. Technical Lead:
22. Date:
23. Phone No.:
24. Person Assigned:
25. Requirements Analyst:
26. System Version/Release:
27. Impact Statement (Note any/all system downtime):
28. Level of Effort/Time Estimate:
29. Projected Start Date:
30. Projected End Date:
31. Configurable Items (CIs) Affected:
ENGINEERING REVIEW BOARD (ERB) RECOMMENDATION (Optional)
32. Disposition:
____Approved
____Conditionally Approved
____Disapproved
____Withdrawn
33. ERB or Technical Comments:
34. Authorizing Signatures
Date:
Date:
CONFIGURATION CONTROL BOARD (CCB) RECOMMENDATION
35. Disposition:
____Approved
____Conditionally Approved
____Disapproved
____Deferred
____ Withdrawn
36. Target Release:
37. Release/Implementation Date:
38. Approved Priority:
____Routine ____ Urgent ____Mandated ____EMERGENCY
39. Comments:
40. Authorizing Signature(s)
Date:
Date:
Date:
Date:
Revised Form AD1168 (07/26/04)
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Parent category: Business