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GENERAL INFORMATION <br />Change Request W )C a) <br />ProjecrlClty,cwnty <br />Requester Name <br />CesnnpWn of Change <br />Dale Submitted <br />Prb* <br />Reason For Change Request <br />ProjectAmfmix Impacted <br />Avoi SaFturxe Change Regrwix Fnrm <br />Coy of5mnevntte <br />J <br />J <br />[Enter a detailed d2scripUm of dw ciha WE being requesmdJ <br />� J <br />Low � Madam 1 .�-t Required <br />I`EnrarBdetaded de3el>pbGllda�IJ+�Ia ferMVgl 1a86YNg Rgl1@3,}ed,_ <br />ri.iat ocher artitachr aReded by gee chave <br />Assumptions�Risks �loarrwr/aaorwtp&aar orootteneands rrgardYrgl lha ,agrwalad el4ngaj <br />�nteral�� J <br />Commen�lConsideratioas <br />AtlachmerrusiReferenoes <br />E STIMATE S <br />Total Estimated Development Hours <br />pkWXiihn-111a <br />hour errpacl at the requested change] I <br />Tool Estimated Development Duration <br />PIK" <br />[Enterihe duration ampool of Me nequeabed dtange]J <br />Schedule Impact <br />g� <br />X)piad hire impact thus chonga mtay 1i on <br />schedules] <br />Cost Impact <br />,PC sq <br />Meo' Ii Mtped!is chmw atayhaua as odd] <br />ComnrentJReoonunendations <br />PM Approval Sgnature <br />Date Signed <br />IDS Approval Signature <br />Cafe Signed <br />CITY OF SOMEWHERE AUTHORIZATION <br />Customer Approval Signature <br />Cate Signed <br />AW MI aWMl III tM 5 <br />page i at 1 <br />25E-24 <br />