Agency Schedule Detail

Authorization Number : 11001579

Agency Series No. : BEN - 10

Status : Active

Agency Web Link :

Agency : DAS

Confidential Description :

Division : DAS0400

Vital Description :

Section : DAS04000403

Record Title : Documents Submitted to Enroll in Benefit Programs (Change of Circumstances)

Revision : 0

Record Description : Records submitted as basis for enrolling/maintaining dependents in benefit program that could change over time. Includes federal tax return, marriage certificate, proof of joint residency, affidavit of common law marriage, certificate of commmon law marriage, adoption agency papers, custody agreements, foster child court documents, legal guardian court documents, qualified medical support order. HB1 affidavit, drivers license, annual affidavit or student status letter from registrar.

Retention Period	Retention Justification	Media Code	Method of Disposal
When fiscal year is complete, maintain records for that year for two years or until that year is audited by the Auditor of State, the audit report is released, and all discrepancies are resolved, whichever is longer, then destroy.		Paper	Shred
When fiscal year is complete, maintain records for that year for two years or until that year is audited by the Auditor of State, the audit report is released, and all discrepancies are resolved, whichever is longer, then destroy.		Electronic	Erase

Approvals

Status	Name	Title	Date
Approved	Jane Kuzma	Records Officer	4/18/2011 10:57:00 AM
Approved	Michael Hardenbrook	Record Administrator	4/18/2011 2:08:00 PM
Approved	Martin Meeks	State Auditor	4/19/2011 10:45:00 AM
Approved	Fred Previts	State Archivist	4/22/2011 2:47:00 PM

Notes

Date	Reason	User