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U.S. DEPARTMENT OF AGRICULTURE 

FOOD SAFETY AND INSPECTION SERVICE 

FSIS Enterprise Governance Board Project Request Form

Please review the following statements before filling out this form:

• If this is a policy related Project which requires no funding, please complete Sections 1 & 2. 

• If this is an Mission Critical Investment (MCI), requires funding, but does not have an IT component, please complete Sections 1, 2, & 3. 

• If this is an MCI, requires funding, and includes an IT component, please complete all Sections. 

• If you have any general questions about the process or the form, please send an email to the following email address: 

1a. Project Title:

 1c. Submitter/POC's Name/E-mail address:

1b. Lead Program Area: 

o FSIS.EG.General@fsis.usda.gov 

1d. Job Title:

1e. Supporting Program Areas/Offices: 1f. Does this initiative/program require funding above and beyond your 

 program area baseline? 

 Yes No

1g. Does this proposal affect any IT systems or require additional technology (including tools, applications, equipment, data, and services)? 

 (If yes, submitter must work with OCIO to assess IT needs) 

• If yes, what IT system is your proposal impacting? 

1h. Is this a new project or existing project? 

1i. This proposal is being requested for the following reason(s): Mandate, Strategic Plan, Directive, OIG/GAO audit finding/evaluation 

 recommendation, new initiative, other (check all that apply). 

 Mandate

 Strategic Plan

 OIG/GAO audit finding/evaluation recommendation

 Yes No

 New Existing

 New Initiative

 Directive Other 

 Please explain:

1j. Please have your AA (s) sign and date the form:

AA Signature: 

Date:

AA Signature: 

Date:

Section One: General Information
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2b. Problem Statement: 

• What problems/issues is your project designed to solve/address? 

2c. Were alternatives to the proposed project explored? 

• If Yes, please explain the alternatives considered and why the proposed solution is the best option in solving the mission critical need. 

• If No, please explain why alternatives were not considered. 

2d. Expected Outcome: 

• Upon completion of the project, what are the expected outcomes (please be specific in your explanation)? Examples include cost 

savings,efficiencies, automation, modernization, compliance, etc. 

2e. How will this program/initiative be implemented?

 2f. Project Impact/Dependencies: 

• Does the project have dependencies on other systems, programs, and Departments/Agencies?: 

 Yes No

 • Examples of dependencies/impacts including but not limited to the following areas: 

o Workforce; Policy Development/Implementation; Sampling; Data Collection/Analysis; Performance Measurement/Strategic 

 Planning; Public Affairs; Internal and/or External Partners 

• If Yes, have these dependencies/impacts been addressed and, if so, how? 

2g. Performance Measurement: • What data will you collect/use and/or tools/metrics will you use to determine if your objectives and goals for this project have been 

met? 

2h. Risk Assessment: • Describe the risks both associated with not moving forward with and with moving forward with the initiative (be specific in severity 

and probability of the risks and stakeholders impacted by the risks): • What barriers or obstacles may be encountered with this project, or have been encountered in the past with this problem/issue? 

2i. Timeline: 

• Estimated date for project initiation: 

• Project duration: 

Section Two: Background

2a. Project Description: 

• Please provide a brief description of what this project does and why it is critical to the FSIS Mission. 

• Please provide objectives and goals: 
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3b. Please explain the impact on existing personnel resources:

3c. If this is an existing project/initiative, please provide (as applicable): 

• Date(s) approved: 

• MCI EG Reference number: 

• Original approval conditions from EG board review: 

3d. Future Base Funding Increase: Yes No

3e. If Yes, please provide an explanation of how the baseline funding will be used: 

 

Amount: Starting Year:

3f. Basis of estimated costs, (i.e. source assumption and calculations): 

• Include a draft Statement of Work (SOW) and any reasoning/support behind cost calculations. 

3g. Please explain why the initiative was not in your program area's fiscal year Spend Plan: 

3a. Describe the estimated costs of the project for FY to FY 

Section Three: Cost and Benefits

Estimated Cost:

Estimated Cost: 

Estimated Cost:

Estimated Cost:

Estimated Cost:

• Previously approved amount in the base funding or MCI: $ 

Initial Year: FY:

Out-Year: FY:

Out-Year: FY:

Out-Year: FY:

Out-Year: FY:

3h. Discuss any quantitative and/or qualitative benefits that will be realized. Examples of quantitative benefits include cost savings, reduction 

 in personnel, increase productivity, etc. Examples of qualitative benefits include receiving reliable data, automation, meeting industry 

 standards, etc.
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4a. To which IT Investment is this proposal tied to:

 IT Security and Compliance

 NON-Major IT Investment (examples: ANet, FIMS, etc.) 

 If checked, please specify name/title of the NON-Major IT Investment:

 MAJOR IT Investment (PHIS or PHDCIS) 

 If checked, please specify the name/title of the Major IT investment:

4b. Does this proposal: 

Require Revision of Planned/Existing IT

Use Existing IT

Require New IT

Section Four: Information Technology Needs/Impacts