For Official Use Only
Exemption application
ICT Policies, Standards, Architecture
and Processes
Agency Details
1.1
Overview
Click here for an overview of the exemption process
1.2
Q
A
Name
Please enter your name
1.3
Q
A
Agency
Please enter details of your agency/business unit
1.4
Q
Phone
Please enter a contact phone number. If you are not the contact
person for this exemption application, enter the contact person’s
name and number.
A
Application
2.1
Q
A
ICT Policies, Standards, Architecture and Processes requiring
exemption
From which ICT Policies, Standards, Architecture or Processes are
you requesting an exemption?
Policy
Standard
Architecture
Process
Other (please detail below)
Further
Details
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2.2
Q
A
Term of exemption
What is the proposed term of the exemption? (NB the maximum
period of exemption is the term of the ICT Policy, Standard,
Architecture or Process)
Less than 6 months
6 – 12 months
>12 months but less than 2
years
> 2 years but less than 3 years
>3 years but less than 5 years
Until the expiration of the
current policy/standard
Other (please detail below)
Further
Details
2.3
Q
A
2.4
Q
Category
In general terms, on what basis are you seeking an exemption? [tick
to all that apply]
Financial
Specialised equipments/support
requirement
Policy (e.g./ security, Cabinet
approved initiative, etc.)
What components does the application for exemption cover?
Please fully detail the components that the application for
exemption covers. You should describe in sufficient detail to define
the boundary of the exemption.
A
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Justification
3.1
Q
Reasons/justifications for the exemption request
Please give full supporting reasons/justifications for seeking the
exemption. Explain in detail why the current ICT policy, standard,
architecture or process cannot be utilised.
A
3.2
Q
Risk Assessment
Please provide details of your risk assessment, including any related
mitigation plans, for the proposed exemption.
A
3.3
Q
Current and proposed arrangements
Please detail the current arrangements and proposed alternative
arrangements.
A
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Additional Information
4.1
Office for Digital Government technology and interoperability
standards
Does the proposed exemption contravene any ICT policies and
standards (including technology and interoperability standards)
published by the Office for Digital Government (ODG)?
Yes
No
Q
A
4.2
Q
Identification of ICT Policy, Standard, Architecture or Process
Please identify the ICT Policies, Standards, Architecture or Processes
that are contravened and the extent of the contravention.
A
4.3
Q
Brand of Server
Is the scope of the exemption limited to that of the brand of the
server to be purchased? If yes, please provide details.
Yes
No
n/a
A
Further
Details
4.4
Q
A
Attachment/s [if required to support request]
Please attach any documents is support of your application.
This exemption request must be authorised by your appropriate
Agency/Portfolio Chief Technical Officer/Chief Information Officer.
Failure to provide the appropriate level of authorisation will result in
delays to the processing of your application.
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Please enter the name and email address of the appropriate decision
maker who has authorised this request, and the date that it was
authorised.
Manager Name
Manager Title
Manager Email
Manager Signature
Date Authorised
Please attach a scanned copy of the signed form and email to:
assurance@sa.gov.au
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For Official Use Only