Office of Financial REQUEST FORM

Management (OFM) For Approval of Economic Feasibility Study (EFS)

P.O. Box 43113 Cost Benefit Analysis
Olympia, WA 98504-3113
(EFS Part 2 of 2)

FORM INSTRUCTIONS

An EFS approval request consists of two parts. The first part is the Business Case form, which describes your agency's proposed project in detail. The second is the
Cost Benefit Analysis (this form), which displays the dollar amounts for your proposed project.

There are four tabs (worksheets) to the Cost Benefit Analysis form. Of these four tabs, you need to enter information into three of the tabs. The tabs are color coded. Enter the data
impacting your agency in the Agency tab (green tab), data impacting other state agencies (if applicable) in the Other State Agencies tab (blue tab), and data impacting your
customers in the Customers tab (orange tab). Then the Summary tab (purple tab) automatically computes totals of the amounts that you entered into the other three tabs. You
do not need to enter anything into the purple Summary tab.

General Instructions
Read all of the Cost Benefit Analysis form instructions.
Use the Cost Benefit Analysis form to summarize the revenues and costs associated with your proposed electronic payments project.
The Cost Benefit Analysis form is required to be submitted to OFM along with the EFS Business Case form.

The amounts entered on these tabs should support and match the amounts and assumptions included in sections 2 and 3 of the EFS Business Case form.

The Cost Benefit Analysis form should include amounts that impact your agency, as well as, other state agencies, and the customers, as applicable.
When you enter amounts into the Agency, Other State Agencies, and Customer tabs, formulas will automatically carry over these amounts to the Summary tab and calculate and enter
grand totals for you.
The EFS Cost Benefit Analysis form should net to a positive amount on the Summary tab.

Agency, Other State Agencies, and Customer Tabs Instructions

Include all amounts for your proposed electronic payments project that impact your agency, other state agencies, and your customers on the appropriate tab.
Each of these items should be described in detail in sections 2 and 3 of the EFS Business Case form.
Enter your agency's name and the project title on the Agency tab only. This information will be entered automatically on all other tabs.
Enter only the first fiscal year (i.e. 2011) in which you intend to implement your electronic payments project on the Agency tab. The balance of the years will be entered automatically in
all other columns and tabs.
Round all dollar amounts to the nearest dollar.
Enter all dollar amounts as positive amounts.
Do not add rows or columns to any of these tabs. If you need to provide additional supplementary information, please include a separate sheet(s).
Totals will be automatically computed and entered for you, and carried forward to the Summary tab.

Summary Tab Instructions

Formulas on this tab will automatically compute and enter grand totals of the data you entered on the Agency, Other State Agencies, and Customer tabs.
You do not need to enter anything on this tab.
The EFS should net to a positive amount on the Summary tab.

(June 2021) Tab: Instructions

 ECONOMIC FEASIBILITY STUDY - COST BENEFIT ANALYSIS - AGENCY IMPACT

Enter only in the gray shaded cells in which there are no formulas present. Agency Name:
Do not add rows or columns to this worksheet. Project Title:
Round all dollar amounts to the nearest dollar.
Enter all dollar amounts as positive numbers.
For "Other -" rows with amounts, enter a description in the gray shaded box on that row.

AGENCY IMPACT Year One Year Two Year Three Year Four Year Five
Fiscal years ending June 30, 1 2 3 4 Total
REVENUE
Increased Revenues
Revenue generated and collected from new sources $0
Increased collection of revenue from existing sources $0
Increased compliance with existing laws $0
Increased time availability of funds $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Increased Revenues $0 $0 $0 $0 $0 $0

Decreased Revenues
Reduction in agency revenues due to redirected revenue stream $0
Reduced fines to customers $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Decreased Revenues $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Change in Revenue $0 $0 $0 $0 $0 $0

INCREASED COSTS
One-Time Costs
New hardware purchases (computers, etc.) $0
New purchases of payment processing terminals $0
New equipment purchases (furniture, fixtures, etc.) $0
New software licensing $0
Programming costs $0
Other development costs (payroll and benefits, service contracts, etc.) $0
Reporting costs $0
Marketing costs $0
Training costs $0
Setup and testing costs $0
Installation of new or added phone lines, or other infrastructure $0
Payments Card Industry (PCI) compliance $0
Consulting fees $0
Other - $0
Other - $0
Other - $0

(June 2021) Tab: Agency

 ECONOMIC FEASIBILITY STUDY - COST BENEFIT ANALYSIS - AGENCY IMPACT

On-Going Costs
Internet hosting costs $0
Software maintenance, renewals and updates $0
Reporting costs $0
Marketing costs $0
Payments Card Industry (PCI) compliance $0
Increased reconciliation and accounting costs $0
Increased banking fees (credit card transaction fees, reporting fees, monthly fees, etc.) $0
Increased staff costs $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Increased Costs $0 $0 $0 $0 $0 $0

DECREASED COSTS
Reduced check and cash handling costs $0
Reduced NSF losses and processing costs $0
Decrease in refunds due to more accurate calculations $0
Decrease in staff costs $0
Reduced theft or fraud costs $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Decreased Costs $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
NET REVENUE (COSTS) $0 $0 $0 $0 $0 $0
========== ========== ========== ========== ========== ==========

AGENCY SUMMARY Year One Year Two Year Three Year Four Year Five
0 1 2 3 4 Total

Total Change in Revenue $0 $0 $0 $0 $0 $0

Total Increased Costs $0 $0 $0 $0 $0 $0
Total Decreased Costs $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
NET REVENUE (COSTS) $0 $0 $0 $0 $0 $0
========== ========== ========== ========== ========== ==========

(June 2021) Tab: Agency

 ECONOMIC FEASIBILITY STUDY - COST BENEFIT ANALYSIS - OTHER STATE AGENCIES' IMPACT

Enter only in the gray shaded cells in which there are no formulas present. Agency Name: 0
Do not add rows or columns to this worksheet. Project Title: 0
Round all dollar amounts to the nearest dollar.
Enter all dollar amounts as positive numbers.
For "Other -" rows with amounts, enter a description in the gray shaded box on that row.

OTHER STATE AGENCIES IMPACT Year One Year Two Year Three Year Four Year Five
Fiscal years ending June 30, 0 1 2 3 4 Total
REVENUE
Increased Revenues
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Increased Revenues $0 $0 $0 $0 $0 $0

Decreased Revenues
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Decreased Revenues $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Change in Revenue $0 $0 $0 $0 $0 $0

INCREASED COSTS
One-Time Costs
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0

(June 2021) Tab: Other State Agencies

 ECONOMIC FEASIBILITY STUDY - COST BENEFIT ANALYSIS - OTHER STATE AGENCIES' IMPACT

On-Going Costs
Increased costs to OST for ACH fees (transaction fees, return item costs, etc.) $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Increased Costs $0 $0 $0 $0 $0 $0

DECREASED COSTS
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Decreased Costs $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
NET REVENUE (COSTS) $0 $0 $0 $0 $0 $0
========== ========== ========== ========== ========== ==========

OTHER AGENCY SUMMARY Year One Year Two Year Three Year Four Year Five
0 1 2 3 4 Total

Total Change in Revenue $0 $0 $0 $0 $0 $0

Total Increased Costs $0 $0 $0 $0 $0 $0
Total Decreased Costs $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
NET REVENUE (COSTS) $0 $0 $0 $0 $0 $0
========== ========== ========== ========== ========== ==========

(June 2021) Tab: Other State Agencies

 ECONOMIC FEASIBILITY STUDY - COST BENEFIT ANALYSIS - CUSTOMER IMPACT

Enter only in the gray shaded cells in which there are no formulas present. Agency Name: 0
Do not add rows or columns to this worksheet. Project Title: 0
Round all dollar amounts to the nearest dollar.
Enter all dollar amounts as positive numbers.
For "Other -" rows with amounts, enter a description in the gray shaded box on that row.

CUSTOMER IMPACT Year One Year Two Year Three Year Four Year Five
Fiscal years ending June 30, 0 1 2 3 4 Total
REVENUE
Increased Revenues
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Increased Revenues $0 $0 $0 $0 $0 $0

Decreased Revenues
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Decreased Revenues $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Change in Revenue $0 $0 $0 $0 $0 $0

INCREASED COSTS
One-Time Costs
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0

(June 2021) Tab: Customer

 ECONOMIC FEASIBILITY STUDY - COST BENEFIT ANALYSIS - CUSTOMER IMPACT

On-Going Costs
Increased costs for new/modified service fees $0
Increased costs for convenience fees $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Increased Costs $0 $0 $0 $0 $0 $0

DECREASED COSTS
Reduced travel time $0
Reduced wait time $0
Reduced parking costs $0
Reduced mail/postage costs $0
Reduced late fees $0
Other - $0
Other - $0
Other - $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Decreased Costs $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
NET REVENUE (COSTS) $0 $0 $0 $0 $0 $0
========== ========== ========== ========== ========== ==========

CUSTOMER SUMMARY Year One Year Two Year Three Year Four Year Five
0 1 2 3 4 Total

Total Change in Revenue $0 $0 $0 $0 $0 $0

Total Increased Costs $0 $0 $0 $0 $0 $0
Total Decreased Costs $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
NET REVENUE (COSTS) $0 $0 $0 $0 $0 $0
========== ========== ========== ========== ========== ==========

(June 2021) Tab: Customer

 ECONOMIC FEASIBILITY STUDY - COST BENEFIT ANALYSIS - SUMMARY OF ALL DATA

DO NOT ENTER INTO THIS WORKSHEET. Agency Name: 0

This worksheet contains formulas and will automatically calculate grand totals of the amounts you Project Title: 0
enter on the Agency, Other State Agencies, and Customer tabs.

SUMMARY OF ALL DATA Year One Year Two Year Three Year Four Year Five
Fiscal years ending June 30, 0 1 2 3 4 Total
REVENUE
Increased Revenues
Revenue generated and collected from new sources / Other $0 $0 $0 $0 $0 $0
Increased collection of revenue from existing sources / Other $0 $0 $0 $0 $0 $0
Increased compliance with existing laws / Other $0 $0 $0 $0 $0 $0
Increased time availability of funds / Other $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Increased Revenues $0 $0 $0 $0 $0 $0

Decreased Revenues
Reduction in agency revenues due to redirected revenue stream / Other $0 $0 $0 $0 $0 $0
Reduced fines to customers / Other $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Decreased Revenues $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Change in Revenue $0 $0 $0 $0 $0 $0

INCREASED COSTS
One-Time Costs
New hardware purchases (computers, etc.) / Other $0 $0 $0 $0 $0 $0
New purchases of payment processing terminals / Other $0 $0 $0 $0 $0 $0
New equipment purchases (furniture, fixtures, etc.) / Other $0 $0 $0 $0 $0 $0
New software licensing / Other $0 $0 $0 $0 $0 $0
Programming costs / Other $0 $0 $0 $0 $0 $0
Other development costs (payroll and benefits, service contracts, etc.) / Other $0 $0 $0 $0 $0 $0
Reporting costs / Other $0 $0 $0 $0 $0 $0
Marketing costs / Other $0 $0 $0 $0 $0 $0
Training costs / Other $0 $0 $0 $0 $0 $0
Setup and testing costs / Other $0 $0 $0 $0 $0 $0
Installation of new or added phone lines, or other infrastructure / Other $0 $0 $0 $0 $0 $0
Payments Card Industry (PCI) compliance / Other $0 $0 $0 $0 $0 $0
Consulting fees / Other $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0

(June 2021) Tab: Summary

 ECONOMIC FEASIBILITY STUDY - COST BENEFIT ANALYSIS - SUMMARY OF ALL DATA

On-Going Costs
Internet hosting costs / Increased costs to OST for ACH fees / Increased costs for new/modified service fees $0 $0 $0 $0 $0 $0
Software maintenance, renewals and updates / Other / Increased costs for convenience fees $0 $0 $0 $0 $0 $0
Reporting costs / Other $0 $0 $0 $0 $0 $0
Marketing costs / Other $0 $0 $0 $0 $0 $0
Payments Card Industry (PCI) compliance / Other $0 $0 $0 $0 $0 $0
Increased reconciliation and accounting costs / Other $0 $0 $0 $0 $0 $0
Increased banking fees (credit card transaction fees, reporting fees, monthly fees, etc.) / Other $0 $0 $0 $0 $0 $0
Increased staff costs / Other $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Increased Costs $0 $0 $0 $0 $0 $0

DECREASED COSTS
Reduced check and cash handling costs / Other / Reduced travel time $0 $0 $0 $0 $0 $0
Reduced NSF losses and processing costs / Other / Reduced wait time $0 $0 $0 $0 $0 $0
Decrease in refunds due to more accurate calculations / Other / Reduced parking costs $0 $0 $0 $0 $0 $0
Decrease in staff costs / Other - Reduced mail/postage costss $0 $0 $0 $0 $0 $0
Reduced theft or fraud costs / Other / Reduced late fees $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
Other - $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
Total Decreased Costs $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
NET REVENUE (COSTS) $0 $0 $0 $0 $0 $0
========== ========== ========== ========== ========== ==========

ALL VIEWS SUMMARY Year One Year Two Year Three Year Four Year Five
0 1 2 3 4 Total

Total Change in Revenue $0 $0 $0 $0 $0 $0

Total Increased Costs $0 $0 $0 $0 $0 $0
Total Decreased Costs $0 $0 $0 $0 $0 $0
-------------------- -------------------- -------------------- -------------------- -------------------- --------------------
NET REVENUE (COSTS) $0 $0 $0 $0 $0 $0
========== ========== ========== ========== ========== ==========

(June 2021) Tab: Summary