Agency Schedule Detail

Authorization Number : 15900330

Agency Series No. : DMR-CS-02

Status : Active

Agency Web Link :

Agency : DMR

Confidential Description : Files may contain Personal Health Information

Division : DMRMedP

Vital Description :

Section : DMRMedP

Record Title : IIF Information

Revision : 1

Record Description : MRDD uses Individual Information Forms (IIF)that are submitted by the county board to develop the sample used in their review process. "IIF Information" includes demographic information specific to an individual receiving services, including date of birth, address, county of residence, family dynamics, types of county board programs/services utilized. NOTE: These units use the information that is gathered by another Department, and are not considered the primary holder of these records.

Retention Period	Retention Justification	Media Code	Method of Disposal
Retain for 6 years	Files may contain Personal Health Information which is required to be kept for 6 years and is protected by 45 CFR 160,165.102-106.164.500-530.	Paper	Shred
Retain for 6 years	Files may contain Personal Health Information which is required to be maintained for 6 years and is protected by 45 CFR 160,165.102-106.164.500-530.	Electronic	Shred

Approvals

Status	Name	Title	Date
Approved	Brooke DAngelo	Records Officer	7/25/2018 2:26:00 PM
Approved	Bunnie Jones	Record Administrator	8/28/2018 1:12:00 PM
Approved	Fred Previts	State Archivist	8/29/2018 1:48:00 PM
Approved	Martin Meeks	State Auditor	8/30/2018 1:15:00 PM

Notes

Date	Reason	User