AGENCY: Department of Health and Human Services. Healthcare Administration. Division of Integrated Healthcare. Office of Eligibility Policy

SERIES: 13971
TITLE: Baby your baby presumptive eligibility applications
DATES: 1987-
ARRANGEMENT: Alphabetical by applicants last name, thereunder chronological.

DESCRIPTION: These applications are used to determine client eligibility for the Baby Your Baby Program/Presumptive Eligibility Program. In addition, these applications are used to support the Department's eligibility to participate in the Presumptive Eligibility Program. The information includes the name of the applicant, address, social security number, Medicaid number, birth date, residency information, insurance information, income information, determination of eligibility and date and signature of person certifying the eligibility of the applicant.

RETENTION

Retain for 10 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

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

APPROVED: 12/1997

FORMAT MANAGEMENT

Paper: 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

This disposition is based on the administrative needs expressed by the agency for conducting audits.

PRIMARY DESIGNATION

Private

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