AGENCY: Department of Health. Bureau of Information Technology

SERIES: 83651
TITLE: Provider payment statement
DATES: 1986-1989.
ARRANGEMENT: chronological by year

DESCRIPTION: Provides a record of payments paid to a medical provider. Information includes the provider's name, address, tax identification number, provider number and total annual payment.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series were specifically approved by the State Records Committee.

APPROVED: 10/1999

FORMAT MANAGEMENT

Computer output microfiche master: Retain in Office for 1 year and then transfer to State Records Center. Retain in State Records Center for 9 years and then destroy.

APPRAISAL

Administrative Fiscal

PRIMARY DESIGNATION

Private

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