Change Request Form

CR Control #:
(assigned by the Project Manager) (use format CRnnn)

1. Requester Section
1.1 - Requester Information (completed by Requester)
Project Name/Number:
Requester’s Name: Name of person making the request.

Requester’s Business Area:

CR Prepared by:
Request Date (MM/DD/YYYY):
1.2 - Proposed Change Description (completed by Requester)
Proposed Change Description and Reference
Provide information below concerning the requested change. Fill in with appropriate information or place an “N/A”
next to those that do not apply:

Description:

Justification: Provide a reason for the change being requested.

Impact of Not Describe the impact if the requested change is not implemented.
Implementing
Proposed
Change:
Alternatives: Describe possible alternatives to the requested change.

<optional>
Priority: Critical High X Medium Low
(check one) considered to be considered to be has the potential needs to be
imperative to the important to to impact addressed if the time
project’s success the success of successful and budget permit
and may have a the project completion of the and is managed as
detrimental impact project but is not resources are
to the project if not an immediate available
addressed promptly help nor
hindrance

Change Request Form Page 1 of 3 Last Updated: June-18

 Change Request Form

4. Impact Analysis Data (completed by Project Manager)

4.1 – Review Detail
Review Date: (MM/DD/YYYY)
Baselined Deliverables 
Affected by the CR (list):
Final Review Results:
Change Impact: (check all that apply below)
Scope Expand Requirements Expand Artifacts Increased Functionality
Reduce Reduce Reduced Functionality
Clarify Clarify Revised Format

Schedule Lengthen Resources* Increase Budget* Increase

# Days Decrease Decrease
No Change No Change
Shorten
# Days

No Change
* - If there is a requirement for additional project resources or budget and the cost of these resources cannot be
funded within the Director’s cost center(s), the ‘net new’ funding must be approved by the Portfolio Prioritization
Committee (PPC).
Section 4, Impact Analysis Data, continues below

Change Request Form Page 2 of 3 Last Updated: June-18

 Change Request Form

4. Impact Analysis Data (continued)

4.2 – Requirements Detail (completed by Project Manager)
Specific Requirements Definition
Enter additional Resource and Capital Expense requirements below.
List Resource (labor) requirements with role, Work Effort and extended Labor Cost (ex. Developer, 80 hours, $3200).
Capital Expense = off-shore resources and new or additional hardware, software, licenses, infrastructure, etc. List
Capital Expense with brief description and total cost (Ex. WebLogic upgrade, $6500; Offshore (TCS), $7800).

Resources Capital
Expense
Additional Requirements Work Effort Labor Cost Non-Labor
(insert rows as needed): (hours) Cost
$ $
(role or capital expense name) (blank if capital (blank if capital (blank if resource)
expense) expense)

Customer team (Optional) 4 $ $

SAP/Ariba Team 8 $ $
Partner Team (Optional) 8 $ $

Totals 20 $ $
Offsetting Change Request(s): Work Effort Labor Cost Non-Labor
<if applicable> (insert rows as needed) (hours) Cost
Enter Name/CR Control #, Work Effort, labor and non-
labor costs from CR(s) used to offset this CR

(Name/CR Control #) $ $

$ $

$ $

Offset Totals $ $

NET COST IMPACT

(Total Work Effort, Labor and Non-Labor Costs minus
Total Offsets) (Total Net (Total Net Labor (Total Net
Hours) $) Non-Labor $)

Alternatives: Describe possible alternatives to the requested change.

<optional>

Change Request Form Page 3 of 3 Last Updated: June-18