Agency Schedule Detail

Authorization Number : 855-1189

Agency Series No. : OSC-3

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 Premium Audit Documents

Revision : 0

Record Description : Premium Audit Documents including completed audits, payroll summary sheet, recap of premium, reconciliation documents and ARDB requests.

Retention Period	Retention Justification	Media Code	Method of Disposal
15 years per contract, maintain records in the I: Drive.	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 1:40:00 PM
Approved	Sarah Huffman	Records Officer	8/13/2018 2:07:00 PM
Approved	Bunnie Jones	Record Administrator	9/7/2018 2:23:00 PM
Approved	Martin Meeks	State Auditor	9/10/2018 9:15:00 AM
Approved	Fred Previts	State Archivist	9/10/2018 12:45:00 PM

Notes

Date	Reason	User