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Agency Schedule Detail

Authorization Number :  855-1191
Agency Series No. :  OSC-1
Status :  Active
Agency Web Link : 
Agency :  BWC
Confidential Description :  Records may include medical records, the claimant’s name, the residential address, the name of the employer, the address of the employer, the social security number and the residential telephone number.
Division :  BWCEMPS
Vital Description : 
Section :  BWCEMPSOSTC
Record Title :  Other States Coverage (OSC) Employer Policy File
Revision :  0
Record Description :  Policy information for OSC including: completed applications for coverage on the ACORD 130 form, supplemental applications, quotes for coverage, copies of issued policies, endorsements, cancellation notices, non-renewal notices, denial letters. All documents are saved into UDS.
Retention Period Retention Justification Media Code Method of Disposal
15 years per contract, maintain records in UDS. 15 years per contract with Zurich American Insurance as stipulated. Electronic Delete
If the record is paper (hard copy), then scan and once image has been verified, shred securely. 15 years per contract – if data is in both paper (hard copy) and electric format, hard copy (machine readable) can be destroyed if they have been verified as being identical. Paper Shred

Approvals

Status Name Title Date
Approved Jeff Hitch Records Coordinator 8/9/2018 1:35:00 PM
Approved Sarah Huffman Records Officer 8/13/2018 2:09:00 PM
Approved Bunnie Jones Record Administrator 9/7/2018 2:22:00 PM
Approved Martin Meeks State Auditor 9/10/2018 9:42:00 AM
Approved Fred Previts State Archivist 9/10/2018 12:46:00 PM

Notes

Date Reason User

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