Agency Schedule Detail

Authorization Number : 870-0412

Agency Series No. : 14.20

Status : Active

Agency Web Link :

Agency : PUC

Confidential Description : Contains medical information

Division : PUCCHRS

Vital Description :

Section : PUCCHRS

Record Title : FMLA Physician or Health Care Provider Certification

Revision : 1

Record Description : Form containing medical information in support of an employee''s application for benefits under the Family Medical Leave Act.

Retention Period	Media Code	Method of Disposal
Retain for 5 years after employee separation, then destroy.	Microform	Shred
Retain in office for 2 years, then scan. Destroy paper copy after image checked for quality and completeness.	Paper	Shred
Retain for 5 years after employee separation, then destroy.	Electronic	Delete

Approvals

Status	Name	Title	Date
Approved	Tanowa Troupe	Records Officer	1/26/2016 12:35:00 PM
Approved	Bunnie Jones	Record Administrator	2/10/2016 8:50:00 AM
Approved	Fred Previts	State Archivist	2/10/2016 4:47:00 PM
Approved	Martin Meeks	State Auditor	2/11/2016 2:45:00 PM

Notes

Date	Reason	User