Agency Schedule Detail

Authorization Number : 580-0109

Agency Series No. : REIMB-17C

Status : Active

Agency Web Link :

Agency : DMH

Confidential Description : N/A-Load

Division :

Vital Description :

Section :

Record Title : Receipt for Payment

Revision : 0

Record Description : Top portion of billing form sent in when person makes payment or form completed when a payment is made in person or sent in by mail without the billing form included. Includes amount paid, receipt no., date of payment, etc.

Retention Period	Retention Justification	Media Code	Method of Disposal
Retain in office until single audit performed by the Auditor of State and the audit report released and all discrepancies resloved then destroy	No value at Conversion	Paper	Shred

Approvals

Status	Name	Title	Date
Approved	Transfer User	Records Viewer	8/14/1991 12:00:00 AM

Notes

Date	Reason	User