Department of Financial Services
Division of Accounting and Auditing
OBJECT CODE STANDARDIZATION PROJECT
Impact Statement Form
1.
Agency Name
2.
Contact Name
3.
Contact E-mail
4.
Contact Title
5.
Contact Phone Number
6.
Impact to agency if request is not approved:
Expenditure Reporting
Business System Impact - Names of System(s):
Other – Please explain:
7.
Impact Statement (Explanation of Impact to the agency include any concerns on timeline)
1
Department of Financial Services
Division of Accounting and Auditing
OBJECT CODE STANDARDIZATION PROJECT
Impact Statement Form
8. Request for Statewide Object Codes (if applicable)
Object Code
Short Title
Long Title
Definition
Justification
For DFS Use
Only
Approved
Y/N
Approved
Y/N
Approved
Y/N
Approved
Y/N
Approved
Y/N
Approved
Y/N
Approved
Y/N
Approved
Y/N
Approved
Y/N
THE FOLLOWING CERTIFICATION MUST BE COMPLETED BY THE AGENCY’S DIRECTOR OF ADMINISTRATION OR DELEGATE.
I hereby certify, to the best of my knowledge, that the information provided above is true and correct.
Printed Name:
Signature:
Title:
Phone Number:
Date Signed:
2