Agency Schedule Detail

Authorization Number : 100-1048

Agency Series No. : HR-02

Status : Active

Agency Web Link :

Agency : DAS

Confidential Description : Series may contain personal information about an employee that would not be considered public record.

Division :

Vital Description :

Section :

Record Title : Employee Benefits Files

Revision : 2

Record Description : This series contains original documents: File copies of all forms necessary for the following benefits: Health Care Enrollment Form (ADM-4317), Exempt Dental & Vision Enrollment Form (ADM-4720), OCSEA Dental & Vision Enrollment, Retirement Application, COBRA Benefits Forms, Accident & Illness Report. Disability: Disability Application, Employee''s Statement & Physicians''s Statement. Supplemental: Employee''s Statement, Physician''s Statement, Burea of Workers Com, Family Leave, Americans With Disabilities & COBRA documentation. Payroll: Tax Forms, Prior Service Records, Savings Bond Cards, Electronic Funds Transfer, Manual Pay for Shortage of Hours, Credit Union, Charity Contribution Deduction Forms, Address Updates and Correspondence.

Retention Period	Retention Justification	Media Code	Method of Disposal
Retain in office area for two years after separation of employee from service with this department, then transfer to storage. Retain for 48 years	This series contains vital information, which may be requested by other employers or employees long after the employee has terminated service with this department	Paper	Shred

Approvals

Status	Name	Title	Date
Approved	Jane Kuzma	Records Officer	7/16/2004 1:43:00 PM
Approved	Michael Hardenbrook	Record Administrator	8/5/2004 10:39:00 AM
Approved	Martin Meeks	State Auditor	8/7/2004 10:46:00 AM
Approved	Laurie Gemmill	State Archivist	8/7/2004 10:46:00 AM

Notes

Date	Reason	User