<Project Name>

Scope Change Request

Date Submitted: <mm/dd/yyyy>
Department: <Department>
Focus Area: <Focus Area>
Product or Process: <Product or Process>
Investigator: <Investigator>
Project or Organization Role: <Role>

Scope definition and impact on other projects and programs

Business and system drivers

Business and system impact

Scope change benefit

Implication of not making change

Scope change cost estimate

Related documentation

Scope change approved for investigation? Yes No

Assigned Investigator: <Investigator>

Approved by: <Approver>
Title: <Title>
Date Approved: <mm/dd/yyyy>

Comments
<Project Name>
Scope Change Impact Assessment
Investigator: <Investigator>
Date Submitted: <mm/dd/yyyy>

Impact on other projects and programs

Issues

Risks

Skill required

Scope change cost estimate

Schedule impact

Impact on systems

Related documentation

Impacted documentation
Business case Schedule Design
Requirements Cost/Budget Plan Code
Specifications Resource Plan Test Cases

Recommendations
Change Control Board Decision Approved Deferred Rejected

Assigned Investigator: <Investigator>

Approved by: <Approver>
Title: <Title>
Date Approved: <mm/dd/yyyy>

Comments
<Project Name>
Cost Assessment
Department: <Department>
Focus Area: <Focus area>
Product or Process: <Product or Process>
Document Owner: <Document Owner>
Project or Organization Role: <Role>

Labor Total
Labor Material Travel Other
ID Task Cost per Labor Total Cost
Hours Cost Cost Cost
Hour Cost

$0 $0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
Subtotal 0 $0 $0 $0 $0 $0
Contingency Reserve
Total $0

Comments: