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Benefit Administration Enrollment and Authorization Forms

RDA Number
11367
Effective Date
Record Series Abstract
Benefit Administration Enrollment and Authorization Forms generated by the Finance and Administration Benefit Division. The record series includes but not limited to Active and Retiree Enrollment Change and Cancel Request forms, Flexible Benefit and Leave of Absence forms, ACH & HIPAA Authorization forms and supporting documentation.
Record Series Active
Yes
Cut Off at End of
Other
If Other, Explain
When employee terminates from the plan
Total Retention Years
65
Total Retention Months
0
Retention End Action
Destroy
Disposition Notes
The records are to be scanned and stored on electronic server, the hard copies are to be destroyed upon verification that the records were properly scanned and uploaded to the server; maintain in agency 65 years after employee/member terminates from plan, then destroy by approved methods.
Allotment Code
31704
Record Location
312 Rosa Parks Ave. Nashville, TN
File Arrangement
Multiple indexing alpha and Edison ID
Date Range
2008-Current
Annual Accumulation
26,221mb 500 CF
Current Volume
25gb 500 CF
Record Value
Administrative
Fiscal
Audit Requirements
State
Information Shared Outside the State
No
Essential Record
No
Confidential
No
Confidential Legal Citation
45 CFR 164.306, 45 CFR 164.304, 45 CFR 160.103
Does this Record Series Contain Sensitive Information?
No
Records Center Retention Period
NA
Record Sample PDF
2625.sample.pdf951.55 KB
System Name
FileNet
Hardware Description
Images stored on two storage devices - Data Center North and Data Center South
Software Description
IBF FileNet Software for Images- Microsoft for Index values
System Location
Data Center North Nashville Tennessee Data Center South Smyrna Tennessee
Backup Procedures
State standard at both Centers encrypted by Enterprise Software
Disaster Recovery
State of Tennessee standard for both Centers using offsite storage facilities
Data Migration Description
Full Migration Plan on File with STS
Legacy Revision UUID
2625