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Agency Schedule Detail

Authorization Number :  580-0964
Agency Series No. :  REIMB-09C
Status :  Active
Agency Web Link : 
Agency :  DMH
Confidential Description : 
Division : 
Vital Description : 
Section : 
Record Title :  Hospital/Holding Account Files
Revision :  0
Record Description :  Computer report showing medicare payments credited to each hospital/account. Shows hospital/account name and no., fiscal year, date and amount of payment/adjustment, etc. Includes the following forms: Medicare Adjustment Voucher (SB-5016A), Adjustment Voucher (SB-5016), or Work Order to Establish New Account (SB-5006A).
Retention Period Retention Justification Media Code Method of Disposal
Retain in office until single audit performed by the Auditor of State and the audit report released and all discrepancies resolved then destroy No value at Conversion Paper Wastepaper

Approvals

Status Name Title Date
Approved Transfer User Records Viewer 8/14/1991 12:00:00 AM

Notes

Date Reason User

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