Program Cost-Benefit Analysis Evaluation Form
Please assess the program’s costs, benefits, risks, assumptions, timeframe, and provide your recommendation. Answer all questions as accurately as possible.
Program Name
*
Brief Program Description
*
Overall Cost Assessment
*
1
2
3
4
5
Overall Benefit Assessment
*
1
2
3
4
5
Risk Level
*
Low
Moderate
High
Key Assumptions (list up to three)
*
Estimated Timeframe for Implementation
*
Please Select
Less than 3 months
3-6 months
6-12 months
More than 12 months
Cost vs. Benefit Matrix
*
Rows
Low
Medium
High
Direct Costs
1
2
3
Indirect Costs
4
5
6
Tangible Benefits
7
8
9
Intangible Benefits
10
11
12
Biggest Uncertainty or Challenge
*
Final Recommendation
*
Proceed
Proceed with Modifications
Do Not Proceed
Submit Evaluation
Should be Empty: