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Agency Schedule Detail

Authorization Number :  11001579
Agency Series No. :  BEN-6
Status :  Active
Agency Web Link : 
Agency :  DAS
Confidential Description :  May contain social security number
Division :  DAS0400
Vital Description : 
Section :  DAS04000403
Record Title :  Benefit Change Forms
Revision :  1
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 common law marriage, adoption agency papers, custody agreements, foster child court documents, legal guardian court documents, qualified medical support order. HB1 affidavit, driver’s license, annual affidavit or student status letter from registrar.
Retention Period Retention Justification Media Code Method of Disposal
Retain current year plus prior 2 years then destroy. Paper Shred
Retain current year plus prior 2 years then destroy. Electronic Delete

Approvals

Status Name Title Date
Approved David Day Records Coordinator 10/23/2025 4:12:02 PM
Approved Denise DePalma Records Officer 11/17/2025 10:19:50 AM
Approved Terri Dittmar Record Administrator 11/18/2025 7:39:03 AM
Approved Martin Meeks State Auditor 11/18/2025 2:29:43 PM
Approved Fred Previts State Archivist 11/19/2025 1:07:17 PM

Notes

Date Reason User

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© 2026 - RIMS, State of Ohio