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Agency Schedule Detail

Authorization Number :  855-0994
Agency Series No. :  RTUN 8
Status :  Active
Agency Web Link : 
Agency :  BWC
Confidential Description :   
Division :  BWCRKAD
Vital Description : 
Section :  BWCRKADRTUN
Record Title :  AC-3 Temporary Authorization form
Revision :  1
Record Description :  The AC-3 is a Temporary Authorization form submitted by the Third Party Administrator (TPA). The AC-3 gives the TPA temporary authorization to review and work on certain BWC matters on the employer’s behalf. The AC-3 is date stamped then scanned into the Universal Document Service (UDS) to retained for reviewing purposes by BWC if needed. The AC-3 is good for only nine months after it has been date stamped by BWC. After the nine month period is reached, the TPA is unable to review or work on any BWC matters for that employer.
Retention Period Retention Justification Media Code Method of Disposal
The AC-3 forms are to be retained for one week after they are scanned into the Universal Document Service for quality assurance then destroy. Paper Recycle
The AC-3 forms are to be retained in the Universal Document Service (UDS) for one year then destroy. Electronic Delete

Approvals

Status Name Title Date
Approved John Cahill Records Coordinator 11/22/2010 2:00:00 PM
Approved Melissa Roach Records Officer 12/9/2010 3:06:00 PM
Approved Michael Hardenbrook Record Administrator 1/12/2011 1:59:00 PM
Approved Martin Meeks State Auditor 1/14/2011 11:14:00 AM
Approved Fred Previts State Archivist 1/20/2011 3:06:00 PM

Notes

Date Reason User

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