Agency Schedule Detail

Authorization Number : 855-0989

Agency Series No. : RTUN 7

Status : Active

Agency Web Link :

Agency : BWC

Confidential Description :

Division : BWCRKAD

Vital Description :

Section : BWCRKADRTUN

Record Title : (AC-2) Permanent Authorization Form

Revision : 0

Record Description : The Permanent Authorization Form (AC-2) is submitted by the Third Party Administrator (TPA) and/or the employer. The AC-2 provides permanent rights to the TPA to view or access any of the employers’ rate information. The AC-2 is scanned into the Universal Document Service (UDS). UDS is an imaging concept that stores any type of electronic file, such as Microsoft Office documents, Adobe Acrobat, audio/video, Computer Aided Design (CAD), etc. as well as scanned images.

Retention Period	Retention Justification	Media Code	Method of Disposal
The paper AC-2 forms are immediately scanned into the Universal Document Service (UDS) when they are received. After the AC-2 forms are in UDS they are reviewed for quality assurance. If the qaulity is accepted, the paper form can be destroyed.		Paper	Recycle
The AC-2 forms are scanned into the Universal Document Service (UDS). If the policy is cancelled and there is no balance, then retain the electronic files for five years. If there is a balance on the policy, the electronic files will be retained for 5 more years (total of ten years).	Keeping the policies with balances for ten years insures that any outstanding debt due to BWC will be collected.	Electronic	Delete

Approvals

Status	Name	Title	Date
Approved	John Cahill	Records Coordinator	2/27/2008 12:33:00 PM
Approved	Melissa Roach	Records Officer	3/5/2008 10:32:00 AM
Approved	Michael Hardenbrook	Record Administrator	3/5/2008 11:23:00 AM
Approved	Martin Meeks	State Auditor	3/6/2008 9:14:00 AM
Approved	Jelain Chubb	State Archivist	3/11/2008 1:52:00 PM

Notes

Date	Reason	User