Sample (NCA) Program Change Approval Process Form

CST
RC#
Project Name
Project No.
Sub-Project No.

Change Request Description

Requester's Name:

Impact Analysis

Cost Impact

Table Summary

The table shows a cost estimate of impact for consultant, construction, A&ES

  Estimate ($)
Consultant $
Construction $
A&ES $

Time Impact

Time (Number of Days) - Estimate __
Can delay be recuperated? Yes or No
If yes: Description of recuperation

Departmental Representative's Recommendation

Date:

Project Leader's Approval

Cost Impact

Yes or No

Time Impact

Yes or No

Project Leader Acceptance

Name:
Date:

Proposal Cost Sharing

Table Summary

The table shows the proposal cost sharing for end users and PSPC, with coding and amount.

  Coding Amount (dollars)
End Users   $
PSPC   $
  Total $

Comments

Departmental Representative

Senior Project Manager