State of New Mexico Change Request Number

ADMINISTRATIVE Department of Labor MIS

SERVICES DIVISION
Information Systems Bureau INFORMATION SYSTEMS WORK REQUEST User
FUNCTIONAL AREA:
Office of the Secretary Programs Employment Security Administrative Services
Internal Labor & Industrial Economic Research Financial Management
General Counsel Human Rights Field Services General Services
Public Information Job Training Appeals Information Systems
Other Unemployment Insurance Human Resources
I Quality Control Internal Audit
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I DESCRIPTION OF REQUEST
T TYPE SUPPORT REQUESTED
I System Requirement Definition Addition to Existing System One-Time Report or File Maintenance
A New System Development Modification to Existing System Special Project
State the purpose of your request. Describe the work that is to be done. Include your specifications detailed information relating to how
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data enters, is processed and is reported by the system. If possible, describe the present systems and what changes are to be made.
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Attach copies of forms, screens and reports, if they are available.
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G

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Benefits of Completion/Consequences of Tardiness Must be in Production by:

Month Day Year

Requested Production Date:

Month Day Year

Requestor's Name Phone Location Supervisor's Signature Request Date

THIS CHANGE REQUEST HAS BEEN: REQUIRED APPROVAL: IMPACT CATEGORY

S 1 - Federal Mandate with Financial Impact
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Accepted for Processing Not Required 2 - Court Ordered Mandate Change Request
G Returned for Revision CIO Review 3 - Legislative Mandate Reviewed by MIS:
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Rejected (see attached explanation) I.S. Plan Modification 4 - Audit/Accounting Mandate Month Day Year
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Reviewed and passed to Federal Grant 5 - Error Rate Reduction
P User Group 6 - Federal Mandate Without Financial Impact
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I 7 - Problem Resolution
N Single Point Signature Date 8 - Plain Ordinary Enhancement
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9 - Large Cost Savings

Incident Report New Change Request Management Report

Software Re-engineering System Tuning and Maintenance Special Projects
Date Received Date Entered Initials Date Closed Out Initials
CONTRACTOR