AGENCY: Department of Health. Division of Medicaid and Health Financing. Bureau of Authorization and Community Based Services

SERIES: 8134
TITLE: MAO excess income computation
DATES: 1983-
ARRANGEMENT: None

DESCRIPTION: This is a form used to determine if applicants for medical assistance meet the income requirements of the program. This form is also used as an input document for the MMIS data system. It includes the client's name and identification number, the category of aid, the source of the client's income, the amount of countable earned and unearned income, the amount of excluded income, and the date the income was received, and calculations by category of service of the client's income and deductions, and the dollar amount of excess income the client receives.

RETENTION

Retain for 4 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 08/1986

FORMAT MANAGEMENT

Paper: Retain in Office for 6 months and then transfer to State Records Center. Retain in State Records Center for 4 years and then destroy.

APPRAISAL

Administrative Fiscal

This record is subject to federal audit. The audit period is three years, however, since the federal government operates on a fiscal year basis, the records should be kept 4 calendar years. The only office use of this record is to verify that the information was correctly input into the data system. Previous decision: RDR 76-54: 3 years/private.

PRIMARY DESIGNATION

Private

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