AGENCY: Department of Health. Medical Assistance Program

SERIES: 7880
TITLE: Transmittal of collections
DATES: 1985-2014.
ARRANGEMENT: None

DESCRIPTION: This form is used to transmit cash received by the bureau to the department's Bureau of Finance. It includes the dates covered by the transmittals and the range of the receipt numbers attached to the transmittals, the date of payment, the receipt number, the client's identification number, the name of the client, the name and address of the payer, the relationship of the payer to the client, the total amount paid, the name of the clinic submitting the transmittal, the date prepared, the names of the individuals preparing and approving the report, and the total amount of cash received by page total and by transmittal total.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then transfer to State Records Center. Retain in State Records Center for 1 year and then destroy.

APPRAISAL

Administrative

The copy kept in the clinics is a duplicate. The original is sent to the department's Bureau of Finance and they should have the responsibility for keeping their copy for any audit period.

PRIMARY DESIGNATION

Private