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DOCUMENT DESCRIPTION

This is a Change Control Request form built in MS Word. The form contains the following sections:

A. General Information – Basic information that identifies the project.
•  Project Title – The proper name used to identify this project.
•  Project Working Title – The working name or acronym used to identify the project. If an acronym is used, define the specific meaning of each letter.
•  Proponent Secretary – The Secretary to whom the proponent agency is assigned or the Secretary that is sponsoring an enterprise project.
•  Proponent Agency – The agency that will be responsible for the management of the project.
•  Prepared by – The person(s) preparing this document.
•  Date/Control Number – The date the request is initiated and the change or configuration item control number assigned.

B. Change Request Information - The requester provides information concerning the requested change along with any supportive documentation.
1. Proposed Change Description - Describe the proposed change.
2. Justification for Proposed Change - Provide a justification for the proposed change.
3. Impact of Not Implementing Proposed Change - Explain the impact of not implementing the proposed change.
4. Alternatives - Identify other actions that may be taken as an alternative to making the proposed change.

C. Analysis of Change Request - The change request originator or other designated individual will provide detailed information on the impact the change will have on the project.
1. Describe Impact on Change or Configuration Item – Describe the impact on change and configuration control items.
2. Impact on Project Budget - Detail the impact of implementing the change to the Project Budget.
3. Impact on Project Schedule – Detail the impact of implementing the change to the Project Schedule.
4. Impact on other Project Resources – Detail the impact of implementing the change to the other project resources.

D. Change Request Initial Review - A manager within the project organization completes this portion of the request. Typically, the project or program manager reviews the change request. The project manager, program manager, or other designated manager conducts initial review and makes recommendations before the request is submitted to an established change or configuration management review board. Results and recommendations based on the review are provided in this section.

E. Final Review Results - The change or configuration management review board conducts a final review and decides to approve or disapprove the request. In the blocks provided, record and authenticate the decision.

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Source: Change Control Request Word document

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Change Control Request

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