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III
1
3 I1Wl Llf1lIVISIOJ
Offl-~lt_2t_ResearcJ~~1d__~t~0_S~ iS~_ 4 IPMf PEWON WriOM TO (ONrFR or WITH 15-rLl[Xr---_[r l1ur_I_middot BenDSt___ ____ __ _ plusmnS17g ~I _
6 crrn rrICAT[ OF AGENCY IlUIlES[NTATIVi
I her eb r-et-t rfy that I tim EHI h ori ze d tn At OJ the neud of t lus SHetley In ot1 ptrtunIIW 10 the- rlHlpollsl of records and thot the ItlOrdll descrtbed In thll bit
8fhNhdl I r lt23_ page ar-e propfHH d (II ChrpORid for t he rnJOn l11d1lt ate-d (ampIX onlv one)
A 1hc r c o ed e h a v e B The- re cor r -111 rC91C 10 have oqUh~ICllt uollU_ - -] l euwd to have (l11(Jl to war r mrt turt her rt tr ntmn OJ t he cXJlretlt~1
(llnt vallI to HcrfJ~t of the p_1mlt of I tm c mUll at ed or on the ocr ur [ __ further rll en t H -n -I-ITIlt-l1l( evt nt j1nhvl
Dept Records Mgt Officer (Title)
B nCS-R1PTIUN or I reM IITM NO (WIIH IIKlUlif DAT[S OB Rl reNTON ERDOraquo ~~~~-~OOR ArTlO~O TAKEN
------ - ---- ---- -- ------------ ---- ----------- I-------- --------
nEconD~3 RETENTION AND DISPOSAL SCREDULE OPJIICE OF RESEARCH AND STATISTICS
The lec )rds de ocrrbed in this Schedule are accumulated by 11-2 1-)[TicC )1 Research and Statistics However all of I be ](~C01c13 ru-e not mai nt a i ned in any s i ng Le offr ce
1 RESEARCH(RAIIrrJ MID CONT8ACTS -RECORDS
The se recJrds ncc umulat e an the pr-oce s s i ng of applica-i jrlrJ fur Glmrt and contracts which are awarded under l he I 1113 t_ fund md ~ran1 s program
A (ro11L3 PrugriJll RF(ords
JllOSE recr)rdG ( ]181 ot of a pp lt ca t r oris for cooper-at r ng
lYltllrch or c1cml1ls1la1lon erRntc the fLnaL lcp)r 1)1 J1U1oeL1 prnYjclS rind r-e Lat ed cOlr~sp(mdcnce
1 flppllca lOllS for Complei cd ProJect-s
D0~t roy ) YColc n fl or comple t ion uf projec
---------------
~ or
111 II f I 11111 ~C II ~iI~
jill 1 - 11 I Il II ( I I I I t Ill foil NI) I I I I -- I 11
11 Till 11 fl
r 1[ II
It~ It
r 111(1~1 lld I ~ r I
rH IrL~1 II I II If) I hl( -n
9 l~PI r (IF
J )fl rHJ r[lI)N
1iJ 1111lt1fmiddot
I A
3 C0pies of FIDal R~ports
a Record Copy
Retalll permanenlly
b Qi- her COJj es
Deslroy after 1 year
h JmiddotfJrrlrcl cont r-ac l proposals rnc Lud i ng Forni IU~f- I~N(~gottat ed Contract J nvo i ce s 11 ~~rlLces and r-e La l ed (111f3rnndence
Des I roy 3 yt~rJ af i 1 complet ion of cont ract
2 lr~ques to s rn Prop lsnls
a Reject ed proposals
Desiroy 3 years after date of deC1SJOn
1 jlCtrcll pr()pxals r e La+ed c01rl~JpJlIdFmce and fllnl lepurt s bull
(1) flc L troy contracl
3 yc~r3 a It(1 conrplet 1011 l) f
I vr ~c~~_--- 1
TIel81 n pc rmanent J y ~ ~~rl~ubullbull1
j)r3troy a th~r 1 year Fop copies u ludang onglnal to bo ubl1utlud 10 tho Nahollcal AJchlVCf and Recolda Se vjtlo
411111111 I jill XCI I(f of
ftI- I I I r I J f Il I I r I IJ I I I )
I I 1 )
Er()Ul~~~ (0[lt jl]lI(Jl( tTY TO nrsrosr or RrCORDS--ContinunUon fJhed
Ilf I I ) J I t~ r)( I 11 1 c-IIP~ [ or 10
III M Ni) t 1 t 11 lP-1 l J11 ) I~ I lll(lj r1lI11hl rc II tl r AKENJ 011 r~1)
c Ad vj sorv COllllill i Ife Records I I
lhe se records cons is t of nunute s of meet r ngs conunentfJ
and r-epo rt o of an aunua ILy a ppo int ed commit tee which lS eslablLshed to reVlew appllcatLol1s for 131unts and cont ract s and to decide whether to fund or reject n gJven project
Irnna Ie r to i he FRC when no longer needed for l(frrcnce Des tr-oy after 20 years r-et errt Lon In 1 he PRC
111lt( 1(C(llCL ccnci raquot (1[ corlc3pondcncc bet ween )[A
rllll1 l he O()(lCll and Rchab i Li t a t r on Service (sm) l=sordInL Ulf l und i ng of [rrtnt and cont r-ac t c _PS lKI~ Con[le~ L-1101 aut hor ity to d i aper-ae these func1s
Ir-arioIe r lo the FRC whe n no longer needed for I re [er(_nce Iie t a i n permanently plusmnli Lite Ffte
II nrrETlFlTIONAL 3TAFF RECOnnS
These docum=nt r ac c umuLa le t n the co I Lec t r on of da t a reJat llll~ to coc i a L secllrlty plocrmns of all (_UlJJ t l Ll~ bull TF~ 1 wul j ani Irnd Ln~ ar-e pub I i shed ever1 id) 0rll~ 1 ()ltI1I ~CCJlLI1 ThrOlwhcgtut the itnld t eLl 111enlllllunl a r t uLec In lip)
r 1fgt I~ll_ -_lmiddotI~middotI- B1l11fLJn and foreJgn il111111_clJ 111 ]l(l~d rll 1pero Jt(s(~l1tec1 at Illi (j 11 L )]1 L iJmiddotc(i I I Uld lclrl -lt~ll C01leCpOllc1cllce
43 _ ~
I Tnt o rna l LUl1nl MeelLllg
lllni I iu I lll ]lie when no I I]Jf~et ne eded forI
PillVliKl]i
I 3 fJ1 ()I 11(_1 ~11j1ln1
----------- ---1 )f-S t-lf-lV-l-l-t eF-)-+q yenamp--- _ Fou COpJCUI1 Includtng anginal to bo suhrnJUod to thn Nnhnn 1 L I 111 c ~ __
bullbull L
~C1tdlJld J flllll in rr-a II I 1 IJ lr 4I Ie II I ~ I I I l I I I II 1111 Jolgt No Pi~middot - J I I
p-rQUCST FOI- lUTHORITY TO DISPOSE OF RECORDS--ConHnuC1tion Shoet
10B I L IWII IN rf 11P 7 SJMPI L OH IT ~NO Ion NO111 I dCl ivt [)i11 I I I~ 1middot[ rrrlllOIl PC lun ) ACflOfJ rAKfll
B Tec]u1Lcal L1a1son Records
These documerrt c acc umuLate In mairrt a Ln I ng re La t i on-sh i ps be t ween SSA arid ant er-nat rona L soc ia L secur i t y organi~ail(mJ such as the Ent e rna t i ona L Labor Orgl111zat ron the Irrt er-nat i ona L Soclal Secur 1 ty As soc iat i on and the Inter-American Conference on 00clal Securliy Included are replles io inqulries and queat ronna i re s on US Cover-muorrt POllCY corres-pondence re La t J ng 10 appom+ments to commlt t e e c vrh ell research s pec Lfi c soc i aL se c ur-i ty prob Lemc de ve Lop que at ronna r rec and prepa re reports Also r nc I lldec1 are document s r-eLat ing Lo development of iielnot rona L a[reemeni s on soc i a L secur i t y such as correspondence bet1tlOen member-s of the nego t La l Lng t eam oIJLc i a L reports of meet i ngs co p re s of the Ii na L acreement 111terpretaiJ ens of the agreement and auZ11HllY agreement s The offLc ia L copy of t lie acreelilenl 1S mar nt a ined ln the Depar+ment of Stale
1 Repl1cs 10 Inqu1rles and Questionnaires
Destroy af~er 3 years
2 Corrmuttee ApPoln111Ient Correspondence
Destroy aftc r ~~yorrrs
3 DoclunellLr Rclni1ng to International Agreements
I I I
Ic I
1lIr~J rlOCllJlJIIJl c 1cllunulaLt In DlraJl~lng 101 Lral11111g JI 1 IUnlf~ll mil i oni Ls 111 soc ia L ~AlULLy educat i ona I plUI_lllIlJ IJJIHjrd Cllt-~ Lis t c oLlllo~c pc ruons rcllr~d t ru r nr n cur r r cula and lt~lQle(1 currrsponc1en e (Il GI Lnch1ucd 111 dnCl~JI-llta cc mnulaled LIt pro vrd i ng lrchJ1J ci I 10 11 ll1l(~ j c) I he ACCllCY IUl JllLernal10nal lr_W]t1IJl_n tJr1 ul he r rlGencles lfCc11r1iJlG pa rame te rr _J 0_1gt1 AUUll i I (~CblnCal llef-c111 dcvc l oping (~U1D 11 r and (~OlI(fJJ)(JllUc1tleL)(lll 01 her count i-i cs rr]t lll t) I lie i r lHeclJ
---__----------------__--------IfI-bU42R3 GPOFon copie includang onginal 10b subnutted to the Natiopul Archive Gndaecord Selvia
__
5
10
11
nd ud J PI 11 -41 Illft HI I Imiddotd r lit I I I I III II
L
I I I 11 No Ii H In
lltrQUIf~1 tOR AUTHORITY 10 DISPOSE or RICORDS--Continnaiion Shcrl
~--------------------- ----------__-------J
I fgtl )IPllor 01 1111 ~iI1II[( l non 1ilU NrllI1 ILl I ~Ijl I )11) ~In 1~llrl~111N PEllf))) IUD rio
1 TraJ rll n~~ LlGi-S ond Curricula
I
TranGfer lu ~Er when no longer needed for I reference trl perrnanently bull in the PRe I -
I
I I 2 All other HxlerJ31
Destroy ofter 3 yeorc
III PUBLICA1IONS EECORDS
These d oc uments relote to i he publ i catLon of ORS s t udae s such a s the E ( ~) 1bleG the MdLcare Data Serles and the Dlsab LIHy ApplJ cauls Statlstlcs Included are earner-a c)PY md nq=ot ive s of the pub li ca t a ona Forms IWil-26 Requ i s i t ron for Duplt ca t ing Phot ograprn ng and MJGcolJaneolJs Pi-oc e s s i ng GSA-lOO SSA Pr i nt ing Requ i s i t ron a nd e qut valent documents
A Documen l G l lttHlg toR amp S Notes
13 AI] Other 113borlal
Des t lOy a 11 (1 2 yeur c
IV ElJJLUATI()I AND JlEASllREHrJlIT SYTEH RECORDS
Ihe sc record arcumulrrt c rn r=valuoLlng a sample of lCCllt lclJuclLCl lL)l1S o l bas i c ESDI c La Lm8 The c La irns )112 rCllT__) I-PC( -) (lei -11111 no If related po Lr c i e s and prucellulJ nrC 1)1~Lil [sClveri TIle delta LS t iansfer r ed Irom ho cnd1 p~~ ~llr(~j J Forme CO-lJc) JMCase Codi ng unde r rT 111(1 Ii-t--llll 1_111f~lli 1 t 1rltl~llt CO-l125A mm JulJGCltIUl rUP[ ~ll~ -J-Ci)YJ l()1 fJdL1 rind Ce ne r-aL and equ r vnIr-n [Jrlllf I (I llUlchcltt]J ~1l(1then to lnpc from Fll~(~l I pr od uc eo t rbu lu t od 1LgtlulC Tnc Ludrd is F01111 ~Sj-l)W~ tH~ C1se Cllllemiddotl llcci ul11lth 1 lhe mean
cout ro I ]01 re]I T_llPllClll III ~ll h 1r1t2LlGCce Lec i ell [(11 GLlrllpl ~lll~ II l ~ upla l u w 1 th I1U l 11 i onc u [ develop-mCEI )L cuc h cn~) u id ~c ClJJ-cl1cclcd 1ColllGt the da t a h(l( 11I(hcU]IIllW hnrlcl~rIS1IcG o I i he ClCG SSll-J40 l lll ( J I JJld
Faul (op bullbullbull huluding oiSJinal to b bullbull uInutlud 10 the Nal10nul Archive and Record SIVIC jf-- 50~8-2 GPo
- I
1H 111111 I I ~II - r 1 r I bull I I ) I J I r I r I ru I ~ r bull I I ~ I [ 11I
1 Ill 1 H
RLQlJCGl fuR i~-UTHJf(I1r TO DISPOSr OF ruCOfDS-Conlinuulioll Dht-ei
-------------------_ ---- --- _ _
[I III I I II I 101J 1- III 1 ~I 10
rif1 r (I LM 1lt) 11 I~ Ll1middot rv tll )11 11II() I r hlL~) JOII 110 ~Ll hl~ 1~XlN
1
Iho l a bu Ln _ed Li u I Illr~J are uccd to prepare reporL s wh i c h ] CC1VET Inct ors or f~Dl ent i t Lement and whi ch analyze the i c or-r-ec t ne cc of t he OrLL3-Lnalfinding These rf~purts I 1nc Lixle
I
A ~cl1nallnual Repurt i
Plellllllllary Dd a on Pol icles and Procedures ReC8rdlnlt lillt lal En I tlemellL Lo R3DI BellefJts I
I
Peporl on rOllC1CS and Procedures f(lr Jmiddottabl-Lslung 1111 I -La Ent J Llemltni I u R3DI BcnefllJ
RePIJlLc i aued 83 requested by other bureaus and office) on such s~)Jects as ieleserv-Lce and rp])rc3enl311 10 pewees
] and Tabulated
Irn nrfer t c the SSA Holding Area lftr~r ] year Ii-anc Ie r to 111p FRC after 2 yea r-s Destroy nftEr 3 jl(arc lE1ClltlOll in the 1RC
2III Deatr ov 0IlClnal documerit s after uu cr-otr Im h~s I bcen pi-oven a cce pt abl e Retu i n rmcro ta Im ~~ 1
I e- 1Jt1cftJJt_li ~7 c2~- I a~ ~~ I~~---c-b~~ p-a~ ~-t~ ~~~I ) celnwnnml neprt a~ u--~ I lII~tluy alt I~l P b l icut r on 111 unnua L report [
ll1Llrll ~~(P)II 11l pcj n1 HTC1ti ] I
I I V ~laquo~~IlIIll ~l t Pl1Wllj(~ll-1jI I
v
FOUT COPIC1I Inc JUWIUI oglnol 0 bo ubllitt~d 10 Iho NahonaJ Jlrchea and Record Serlco lO-594JR-l GPO
(
J I i1a t ~1 I~~~~III I f I I bull 1~I
Ij I I 1 11
lEUU ClIOpound- AUTBOlIT 1 TO DISPOGB OF mCORm ---ConHnult1lion S11cet
7 1 III 1IIfl)N Of III ~1 I In ()I~11pound 11 NO Ilill l(LUIL [JAIl J ) hi IHfI(d1l It~) In) -11 t r i lOtI I rKf Nj(JIl foiL)
I Iut i La ti ec communfcat i ons t ranspor-t at aon custoclJal~
or oiher serVlces requlred by an offlcej and to the i generol mai nt enunce of an offLc e These records I
include but are not Lumt ed to I
1 Requests for supplies recelpts for supplIes i and equipment requests for djsposal of I equr pment and s uruIn r papers pe rt a Irn ng to offlce supply matters
Destroy after 2 years
2 Requests for pub Lr cat acns and hLank fJnos and other paper-s related to the supply and rhstll-b ut i on uf pub l i cat i ons to Lhe o IIace
Destroy a~ter 2 years
3 Documenlo related to local t rans poi-La t ion and
c us t od iu L ae rv rc e required by an o ffr ce
Destroy after 2 years
4 Requo cts for tnata l Int t on of t-elephones telephone ext ens ionc reques tc for change to Le Le phone d rrcct orres and s mu Lar pa per-s
Destroy after 2 yeo r-o
5 DOClUIlenL G related to ORS par-t rcapat Lon l11 cha r i table a Ifa i r-s such as t he annual Combined Federol Cltlmpalgn
Dosiroy ufLer 2 yeors
6 Documcnts ltlflLed l o bur Ld i ng Iac t Li Lies cuch ac rlour pJ~JIG space surveys reports of need 11)1 idl 1 I LOllClI SJX1CC and r-e Latcd correspolldence
Dc ~j l rr)y Ii Hl1 no 1ltrJ1fr n~ccl od 101 ll fer~nce or (1(111-11 n c lLv t i v L~ cornpleted bull
lll-~t- (l)lUYWlJI Co relate to employee health pr ojec t c SUC]l rlC b l oori 110nai r ons prevent r on shots and rc Lu t t~c1 cU]le~JP()llllell e Irie Luded LJ Fo rm T1EH-516
roar copi~s ioClucbng onglnal to be lIubnuUed to tho Notional Archivos and Rocold Selvico 10- 50middottm-~ GPO
41JIIHflIfl J 11111 0 I tlU
I I I L 1)11111
I ~ I 1 r t I ( r 1 I ~ 1 I 1 dl r ~ I I I 1 I
L~JX)iJLSTrOR IUTlIOHITY 10 DISPOZir or HrCORD8--ConHmlC1tion Sheet
----------- ----- -------- -------- - - ----~----------------------__-__-- ----I 10
l 11 r~() r ION r frN
Acc iderrt Report wluch Hi a quarterly report of all accldenLs occurrlng In DRS
1 Form HEhl- 516
Dest roy aft er 1 year
2 All Other MlterJ al
I Destroy l~ months after occur renee of the ) act Ivi i y
C Report of Luss or Theft
Thu reco rd cons ret s of GSA Form 182 Rep)rL of LJSS or Theft which is prepared after these occurrences
Destroy art (01 4 months
D Records DLSI)OSJilon Records
Iho sc doc umentc rp[h~ct the 10caL1011 a nd Zcr dJSpOGLf ron of rlt(~utrIs retued or transferred out of an o IfLce to the FRe 01 to the SSA Records Ilo Ld i ng Area Included a 1 Forms )F-135 Re corde Iransnu t Lal and TIece i pt SSA- 325 SSA Records Iransnu i tal f~SA-32j Request to Transfer or Djspse 01 HlLerlal Jl1 SA Records Holding Area o I1d t he lr e q11Lva Le nt c bull
De s t i-oy Vl1(=n alJ rtocrrls rcfl(=c1rd on t he Li at lIrfo hcr-n d i s posed n[
l
J~romJJI s part LCl]XltLOn 111 VCUJ_01JS-ret LnJn[ procrcnn 1)lt 11 a c glA fJrnIDE ACI~ Upward fk)1) J I ) 1 y md 3l3 fC l(vel_JplIlent Iuc Ludcd are c11_ ~ll f ~llflnnu IJt~) n1en-eC 11s[ G forwarded 1)y r[llcf 1 oni l Jri-f 1 Lui JOllS and reJaf ed cor-re sponden e be t wetn CJOlliUKltO- Also Lnc Lud=d are Forms m1_ ))0 ln1llll11g TIIqueland Author-r za l Lon llEh1-737
r 11lt0( Yfcltnd3are ucc umulrrt rd I n nc1I1lll1Lsiering ORS
Foul Coplesectl including ongtnal to be submitted to e National II1chive and Records SOlvhe
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
~ or
111 II f I 11111 ~C II ~iI~
jill 1 - 11 I Il II ( I I I I t Ill foil NI) I I I I -- I 11
11 Till 11 fl
r 1[ II
It~ It
r 111(1~1 lld I ~ r I
rH IrL~1 II I II If) I hl( -n
9 l~PI r (IF
J )fl rHJ r[lI)N
1iJ 1111lt1fmiddot
I A
3 C0pies of FIDal R~ports
a Record Copy
Retalll permanenlly
b Qi- her COJj es
Deslroy after 1 year
h JmiddotfJrrlrcl cont r-ac l proposals rnc Lud i ng Forni IU~f- I~N(~gottat ed Contract J nvo i ce s 11 ~~rlLces and r-e La l ed (111f3rnndence
Des I roy 3 yt~rJ af i 1 complet ion of cont ract
2 lr~ques to s rn Prop lsnls
a Reject ed proposals
Desiroy 3 years after date of deC1SJOn
1 jlCtrcll pr()pxals r e La+ed c01rl~JpJlIdFmce and fllnl lepurt s bull
(1) flc L troy contracl
3 yc~r3 a It(1 conrplet 1011 l) f
I vr ~c~~_--- 1
TIel81 n pc rmanent J y ~ ~~rl~ubullbull1
j)r3troy a th~r 1 year Fop copies u ludang onglnal to bo ubl1utlud 10 tho Nahollcal AJchlVCf and Recolda Se vjtlo
411111111 I jill XCI I(f of
ftI- I I I r I J f Il I I r I IJ I I I )
I I 1 )
Er()Ul~~~ (0[lt jl]lI(Jl( tTY TO nrsrosr or RrCORDS--ContinunUon fJhed
Ilf I I ) J I t~ r)( I 11 1 c-IIP~ [ or 10
III M Ni) t 1 t 11 lP-1 l J11 ) I~ I lll(lj r1lI11hl rc II tl r AKENJ 011 r~1)
c Ad vj sorv COllllill i Ife Records I I
lhe se records cons is t of nunute s of meet r ngs conunentfJ
and r-epo rt o of an aunua ILy a ppo int ed commit tee which lS eslablLshed to reVlew appllcatLol1s for 131unts and cont ract s and to decide whether to fund or reject n gJven project
Irnna Ie r to i he FRC when no longer needed for l(frrcnce Des tr-oy after 20 years r-et errt Lon In 1 he PRC
111lt( 1(C(llCL ccnci raquot (1[ corlc3pondcncc bet ween )[A
rllll1 l he O()(lCll and Rchab i Li t a t r on Service (sm) l=sordInL Ulf l und i ng of [rrtnt and cont r-ac t c _PS lKI~ Con[le~ L-1101 aut hor ity to d i aper-ae these func1s
Ir-arioIe r lo the FRC whe n no longer needed for I re [er(_nce Iie t a i n permanently plusmnli Lite Ffte
II nrrETlFlTIONAL 3TAFF RECOnnS
These docum=nt r ac c umuLa le t n the co I Lec t r on of da t a reJat llll~ to coc i a L secllrlty plocrmns of all (_UlJJ t l Ll~ bull TF~ 1 wul j ani Irnd Ln~ ar-e pub I i shed ever1 id) 0rll~ 1 ()ltI1I ~CCJlLI1 ThrOlwhcgtut the itnld t eLl 111enlllllunl a r t uLec In lip)
r 1fgt I~ll_ -_lmiddotI~middotI- B1l11fLJn and foreJgn il111111_clJ 111 ]l(l~d rll 1pero Jt(s(~l1tec1 at Illi (j 11 L )]1 L iJmiddotc(i I I Uld lclrl -lt~ll C01leCpOllc1cllce
43 _ ~
I Tnt o rna l LUl1nl MeelLllg
lllni I iu I lll ]lie when no I I]Jf~et ne eded forI
PillVliKl]i
I 3 fJ1 ()I 11(_1 ~11j1ln1
----------- ---1 )f-S t-lf-lV-l-l-t eF-)-+q yenamp--- _ Fou COpJCUI1 Includtng anginal to bo suhrnJUod to thn Nnhnn 1 L I 111 c ~ __
bullbull L
~C1tdlJld J flllll in rr-a II I 1 IJ lr 4I Ie II I ~ I I I l I I I II 1111 Jolgt No Pi~middot - J I I
p-rQUCST FOI- lUTHORITY TO DISPOSE OF RECORDS--ConHnuC1tion Shoet
10B I L IWII IN rf 11P 7 SJMPI L OH IT ~NO Ion NO111 I dCl ivt [)i11 I I I~ 1middot[ rrrlllOIl PC lun ) ACflOfJ rAKfll
B Tec]u1Lcal L1a1son Records
These documerrt c acc umuLate In mairrt a Ln I ng re La t i on-sh i ps be t ween SSA arid ant er-nat rona L soc ia L secur i t y organi~ail(mJ such as the Ent e rna t i ona L Labor Orgl111zat ron the Irrt er-nat i ona L Soclal Secur 1 ty As soc iat i on and the Inter-American Conference on 00clal Securliy Included are replles io inqulries and queat ronna i re s on US Cover-muorrt POllCY corres-pondence re La t J ng 10 appom+ments to commlt t e e c vrh ell research s pec Lfi c soc i aL se c ur-i ty prob Lemc de ve Lop que at ronna r rec and prepa re reports Also r nc I lldec1 are document s r-eLat ing Lo development of iielnot rona L a[reemeni s on soc i a L secur i t y such as correspondence bet1tlOen member-s of the nego t La l Lng t eam oIJLc i a L reports of meet i ngs co p re s of the Ii na L acreement 111terpretaiJ ens of the agreement and auZ11HllY agreement s The offLc ia L copy of t lie acreelilenl 1S mar nt a ined ln the Depar+ment of Stale
1 Repl1cs 10 Inqu1rles and Questionnaires
Destroy af~er 3 years
2 Corrmuttee ApPoln111Ient Correspondence
Destroy aftc r ~~yorrrs
3 DoclunellLr Rclni1ng to International Agreements
I I I
Ic I
1lIr~J rlOCllJlJIIJl c 1cllunulaLt In DlraJl~lng 101 Lral11111g JI 1 IUnlf~ll mil i oni Ls 111 soc ia L ~AlULLy educat i ona I plUI_lllIlJ IJJIHjrd Cllt-~ Lis t c oLlllo~c pc ruons rcllr~d t ru r nr n cur r r cula and lt~lQle(1 currrsponc1en e (Il GI Lnch1ucd 111 dnCl~JI-llta cc mnulaled LIt pro vrd i ng lrchJ1J ci I 10 11 ll1l(~ j c) I he ACCllCY IUl JllLernal10nal lr_W]t1IJl_n tJr1 ul he r rlGencles lfCc11r1iJlG pa rame te rr _J 0_1gt1 AUUll i I (~CblnCal llef-c111 dcvc l oping (~U1D 11 r and (~OlI(fJJ)(JllUc1tleL)(lll 01 her count i-i cs rr]t lll t) I lie i r lHeclJ
---__----------------__--------IfI-bU42R3 GPOFon copie includang onginal 10b subnutted to the Natiopul Archive Gndaecord Selvia
__
5
10
11
nd ud J PI 11 -41 Illft HI I Imiddotd r lit I I I I III II
L
I I I 11 No Ii H In
lltrQUIf~1 tOR AUTHORITY 10 DISPOSE or RICORDS--Continnaiion Shcrl
~--------------------- ----------__-------J
I fgtl )IPllor 01 1111 ~iI1II[( l non 1ilU NrllI1 ILl I ~Ijl I )11) ~In 1~llrl~111N PEllf))) IUD rio
1 TraJ rll n~~ LlGi-S ond Curricula
I
TranGfer lu ~Er when no longer needed for I reference trl perrnanently bull in the PRe I -
I
I I 2 All other HxlerJ31
Destroy ofter 3 yeorc
III PUBLICA1IONS EECORDS
These d oc uments relote to i he publ i catLon of ORS s t udae s such a s the E ( ~) 1bleG the MdLcare Data Serles and the Dlsab LIHy ApplJ cauls Statlstlcs Included are earner-a c)PY md nq=ot ive s of the pub li ca t a ona Forms IWil-26 Requ i s i t ron for Duplt ca t ing Phot ograprn ng and MJGcolJaneolJs Pi-oc e s s i ng GSA-lOO SSA Pr i nt ing Requ i s i t ron a nd e qut valent documents
A Documen l G l lttHlg toR amp S Notes
13 AI] Other 113borlal
Des t lOy a 11 (1 2 yeur c
IV ElJJLUATI()I AND JlEASllREHrJlIT SYTEH RECORDS
Ihe sc record arcumulrrt c rn r=valuoLlng a sample of lCCllt lclJuclLCl lL)l1S o l bas i c ESDI c La Lm8 The c La irns )112 rCllT__) I-PC( -) (lei -11111 no If related po Lr c i e s and prucellulJ nrC 1)1~Lil [sClveri TIle delta LS t iansfer r ed Irom ho cnd1 p~~ ~llr(~j J Forme CO-lJc) JMCase Codi ng unde r rT 111(1 Ii-t--llll 1_111f~lli 1 t 1rltl~llt CO-l125A mm JulJGCltIUl rUP[ ~ll~ -J-Ci)YJ l()1 fJdL1 rind Ce ne r-aL and equ r vnIr-n [Jrlllf I (I llUlchcltt]J ~1l(1then to lnpc from Fll~(~l I pr od uc eo t rbu lu t od 1LgtlulC Tnc Ludrd is F01111 ~Sj-l)W~ tH~ C1se Cllllemiddotl llcci ul11lth 1 lhe mean
cout ro I ]01 re]I T_llPllClll III ~ll h 1r1t2LlGCce Lec i ell [(11 GLlrllpl ~lll~ II l ~ upla l u w 1 th I1U l 11 i onc u [ develop-mCEI )L cuc h cn~) u id ~c ClJJ-cl1cclcd 1ColllGt the da t a h(l( 11I(hcU]IIllW hnrlcl~rIS1IcG o I i he ClCG SSll-J40 l lll ( J I JJld
Faul (op bullbullbull huluding oiSJinal to b bullbull uInutlud 10 the Nal10nul Archive and Record SIVIC jf-- 50~8-2 GPo
- I
1H 111111 I I ~II - r 1 r I bull I I ) I J I r I r I ru I ~ r bull I I ~ I [ 11I
1 Ill 1 H
RLQlJCGl fuR i~-UTHJf(I1r TO DISPOSr OF ruCOfDS-Conlinuulioll Dht-ei
-------------------_ ---- --- _ _
[I III I I II I 101J 1- III 1 ~I 10
rif1 r (I LM 1lt) 11 I~ Ll1middot rv tll )11 11II() I r hlL~) JOII 110 ~Ll hl~ 1~XlN
1
Iho l a bu Ln _ed Li u I Illr~J are uccd to prepare reporL s wh i c h ] CC1VET Inct ors or f~Dl ent i t Lement and whi ch analyze the i c or-r-ec t ne cc of t he OrLL3-Lnalfinding These rf~purts I 1nc Lixle
I
A ~cl1nallnual Repurt i
Plellllllllary Dd a on Pol icles and Procedures ReC8rdlnlt lillt lal En I tlemellL Lo R3DI BellefJts I
I
Peporl on rOllC1CS and Procedures f(lr Jmiddottabl-Lslung 1111 I -La Ent J Llemltni I u R3DI BcnefllJ
RePIJlLc i aued 83 requested by other bureaus and office) on such s~)Jects as ieleserv-Lce and rp])rc3enl311 10 pewees
] and Tabulated
Irn nrfer t c the SSA Holding Area lftr~r ] year Ii-anc Ie r to 111p FRC after 2 yea r-s Destroy nftEr 3 jl(arc lE1ClltlOll in the 1RC
2III Deatr ov 0IlClnal documerit s after uu cr-otr Im h~s I bcen pi-oven a cce pt abl e Retu i n rmcro ta Im ~~ 1
I e- 1Jt1cftJJt_li ~7 c2~- I a~ ~~ I~~---c-b~~ p-a~ ~-t~ ~~~I ) celnwnnml neprt a~ u--~ I lII~tluy alt I~l P b l icut r on 111 unnua L report [
ll1Llrll ~~(P)II 11l pcj n1 HTC1ti ] I
I I V ~laquo~~IlIIll ~l t Pl1Wllj(~ll-1jI I
v
FOUT COPIC1I Inc JUWIUI oglnol 0 bo ubllitt~d 10 Iho NahonaJ Jlrchea and Record Serlco lO-594JR-l GPO
(
J I i1a t ~1 I~~~~III I f I I bull 1~I
Ij I I 1 11
lEUU ClIOpound- AUTBOlIT 1 TO DISPOGB OF mCORm ---ConHnult1lion S11cet
7 1 III 1IIfl)N Of III ~1 I In ()I~11pound 11 NO Ilill l(LUIL [JAIl J ) hi IHfI(d1l It~) In) -11 t r i lOtI I rKf Nj(JIl foiL)
I Iut i La ti ec communfcat i ons t ranspor-t at aon custoclJal~
or oiher serVlces requlred by an offlcej and to the i generol mai nt enunce of an offLc e These records I
include but are not Lumt ed to I
1 Requests for supplies recelpts for supplIes i and equipment requests for djsposal of I equr pment and s uruIn r papers pe rt a Irn ng to offlce supply matters
Destroy after 2 years
2 Requests for pub Lr cat acns and hLank fJnos and other paper-s related to the supply and rhstll-b ut i on uf pub l i cat i ons to Lhe o IIace
Destroy a~ter 2 years
3 Documenlo related to local t rans poi-La t ion and
c us t od iu L ae rv rc e required by an o ffr ce
Destroy after 2 years
4 Requo cts for tnata l Int t on of t-elephones telephone ext ens ionc reques tc for change to Le Le phone d rrcct orres and s mu Lar pa per-s
Destroy after 2 yeo r-o
5 DOClUIlenL G related to ORS par-t rcapat Lon l11 cha r i table a Ifa i r-s such as t he annual Combined Federol Cltlmpalgn
Dosiroy ufLer 2 yeors
6 Documcnts ltlflLed l o bur Ld i ng Iac t Li Lies cuch ac rlour pJ~JIG space surveys reports of need 11)1 idl 1 I LOllClI SJX1CC and r-e Latcd correspolldence
Dc ~j l rr)y Ii Hl1 no 1ltrJ1fr n~ccl od 101 ll fer~nce or (1(111-11 n c lLv t i v L~ cornpleted bull
lll-~t- (l)lUYWlJI Co relate to employee health pr ojec t c SUC]l rlC b l oori 110nai r ons prevent r on shots and rc Lu t t~c1 cU]le~JP()llllell e Irie Luded LJ Fo rm T1EH-516
roar copi~s ioClucbng onglnal to be lIubnuUed to tho Notional Archivos and Rocold Selvico 10- 50middottm-~ GPO
41JIIHflIfl J 11111 0 I tlU
I I I L 1)11111
I ~ I 1 r t I ( r 1 I ~ 1 I 1 dl r ~ I I I 1 I
L~JX)iJLSTrOR IUTlIOHITY 10 DISPOZir or HrCORD8--ConHmlC1tion Sheet
----------- ----- -------- -------- - - ----~----------------------__-__-- ----I 10
l 11 r~() r ION r frN
Acc iderrt Report wluch Hi a quarterly report of all accldenLs occurrlng In DRS
1 Form HEhl- 516
Dest roy aft er 1 year
2 All Other MlterJ al
I Destroy l~ months after occur renee of the ) act Ivi i y
C Report of Luss or Theft
Thu reco rd cons ret s of GSA Form 182 Rep)rL of LJSS or Theft which is prepared after these occurrences
Destroy art (01 4 months
D Records DLSI)OSJilon Records
Iho sc doc umentc rp[h~ct the 10caL1011 a nd Zcr dJSpOGLf ron of rlt(~utrIs retued or transferred out of an o IfLce to the FRe 01 to the SSA Records Ilo Ld i ng Area Included a 1 Forms )F-135 Re corde Iransnu t Lal and TIece i pt SSA- 325 SSA Records Iransnu i tal f~SA-32j Request to Transfer or Djspse 01 HlLerlal Jl1 SA Records Holding Area o I1d t he lr e q11Lva Le nt c bull
De s t i-oy Vl1(=n alJ rtocrrls rcfl(=c1rd on t he Li at lIrfo hcr-n d i s posed n[
l
J~romJJI s part LCl]XltLOn 111 VCUJ_01JS-ret LnJn[ procrcnn 1)lt 11 a c glA fJrnIDE ACI~ Upward fk)1) J I ) 1 y md 3l3 fC l(vel_JplIlent Iuc Ludcd are c11_ ~ll f ~llflnnu IJt~) n1en-eC 11s[ G forwarded 1)y r[llcf 1 oni l Jri-f 1 Lui JOllS and reJaf ed cor-re sponden e be t wetn CJOlliUKltO- Also Lnc Lud=d are Forms m1_ ))0 ln1llll11g TIIqueland Author-r za l Lon llEh1-737
r 11lt0( Yfcltnd3are ucc umulrrt rd I n nc1I1lll1Lsiering ORS
Foul Coplesectl including ongtnal to be submitted to e National II1chive and Records SOlvhe
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
411111111 I jill XCI I(f of
ftI- I I I r I J f Il I I r I IJ I I I )
I I 1 )
Er()Ul~~~ (0[lt jl]lI(Jl( tTY TO nrsrosr or RrCORDS--ContinunUon fJhed
Ilf I I ) J I t~ r)( I 11 1 c-IIP~ [ or 10
III M Ni) t 1 t 11 lP-1 l J11 ) I~ I lll(lj r1lI11hl rc II tl r AKENJ 011 r~1)
c Ad vj sorv COllllill i Ife Records I I
lhe se records cons is t of nunute s of meet r ngs conunentfJ
and r-epo rt o of an aunua ILy a ppo int ed commit tee which lS eslablLshed to reVlew appllcatLol1s for 131unts and cont ract s and to decide whether to fund or reject n gJven project
Irnna Ie r to i he FRC when no longer needed for l(frrcnce Des tr-oy after 20 years r-et errt Lon In 1 he PRC
111lt( 1(C(llCL ccnci raquot (1[ corlc3pondcncc bet ween )[A
rllll1 l he O()(lCll and Rchab i Li t a t r on Service (sm) l=sordInL Ulf l und i ng of [rrtnt and cont r-ac t c _PS lKI~ Con[le~ L-1101 aut hor ity to d i aper-ae these func1s
Ir-arioIe r lo the FRC whe n no longer needed for I re [er(_nce Iie t a i n permanently plusmnli Lite Ffte
II nrrETlFlTIONAL 3TAFF RECOnnS
These docum=nt r ac c umuLa le t n the co I Lec t r on of da t a reJat llll~ to coc i a L secllrlty plocrmns of all (_UlJJ t l Ll~ bull TF~ 1 wul j ani Irnd Ln~ ar-e pub I i shed ever1 id) 0rll~ 1 ()ltI1I ~CCJlLI1 ThrOlwhcgtut the itnld t eLl 111enlllllunl a r t uLec In lip)
r 1fgt I~ll_ -_lmiddotI~middotI- B1l11fLJn and foreJgn il111111_clJ 111 ]l(l~d rll 1pero Jt(s(~l1tec1 at Illi (j 11 L )]1 L iJmiddotc(i I I Uld lclrl -lt~ll C01leCpOllc1cllce
43 _ ~
I Tnt o rna l LUl1nl MeelLllg
lllni I iu I lll ]lie when no I I]Jf~et ne eded forI
PillVliKl]i
I 3 fJ1 ()I 11(_1 ~11j1ln1
----------- ---1 )f-S t-lf-lV-l-l-t eF-)-+q yenamp--- _ Fou COpJCUI1 Includtng anginal to bo suhrnJUod to thn Nnhnn 1 L I 111 c ~ __
bullbull L
~C1tdlJld J flllll in rr-a II I 1 IJ lr 4I Ie II I ~ I I I l I I I II 1111 Jolgt No Pi~middot - J I I
p-rQUCST FOI- lUTHORITY TO DISPOSE OF RECORDS--ConHnuC1tion Shoet
10B I L IWII IN rf 11P 7 SJMPI L OH IT ~NO Ion NO111 I dCl ivt [)i11 I I I~ 1middot[ rrrlllOIl PC lun ) ACflOfJ rAKfll
B Tec]u1Lcal L1a1son Records
These documerrt c acc umuLate In mairrt a Ln I ng re La t i on-sh i ps be t ween SSA arid ant er-nat rona L soc ia L secur i t y organi~ail(mJ such as the Ent e rna t i ona L Labor Orgl111zat ron the Irrt er-nat i ona L Soclal Secur 1 ty As soc iat i on and the Inter-American Conference on 00clal Securliy Included are replles io inqulries and queat ronna i re s on US Cover-muorrt POllCY corres-pondence re La t J ng 10 appom+ments to commlt t e e c vrh ell research s pec Lfi c soc i aL se c ur-i ty prob Lemc de ve Lop que at ronna r rec and prepa re reports Also r nc I lldec1 are document s r-eLat ing Lo development of iielnot rona L a[reemeni s on soc i a L secur i t y such as correspondence bet1tlOen member-s of the nego t La l Lng t eam oIJLc i a L reports of meet i ngs co p re s of the Ii na L acreement 111terpretaiJ ens of the agreement and auZ11HllY agreement s The offLc ia L copy of t lie acreelilenl 1S mar nt a ined ln the Depar+ment of Stale
1 Repl1cs 10 Inqu1rles and Questionnaires
Destroy af~er 3 years
2 Corrmuttee ApPoln111Ient Correspondence
Destroy aftc r ~~yorrrs
3 DoclunellLr Rclni1ng to International Agreements
I I I
Ic I
1lIr~J rlOCllJlJIIJl c 1cllunulaLt In DlraJl~lng 101 Lral11111g JI 1 IUnlf~ll mil i oni Ls 111 soc ia L ~AlULLy educat i ona I plUI_lllIlJ IJJIHjrd Cllt-~ Lis t c oLlllo~c pc ruons rcllr~d t ru r nr n cur r r cula and lt~lQle(1 currrsponc1en e (Il GI Lnch1ucd 111 dnCl~JI-llta cc mnulaled LIt pro vrd i ng lrchJ1J ci I 10 11 ll1l(~ j c) I he ACCllCY IUl JllLernal10nal lr_W]t1IJl_n tJr1 ul he r rlGencles lfCc11r1iJlG pa rame te rr _J 0_1gt1 AUUll i I (~CblnCal llef-c111 dcvc l oping (~U1D 11 r and (~OlI(fJJ)(JllUc1tleL)(lll 01 her count i-i cs rr]t lll t) I lie i r lHeclJ
---__----------------__--------IfI-bU42R3 GPOFon copie includang onginal 10b subnutted to the Natiopul Archive Gndaecord Selvia
__
5
10
11
nd ud J PI 11 -41 Illft HI I Imiddotd r lit I I I I III II
L
I I I 11 No Ii H In
lltrQUIf~1 tOR AUTHORITY 10 DISPOSE or RICORDS--Continnaiion Shcrl
~--------------------- ----------__-------J
I fgtl )IPllor 01 1111 ~iI1II[( l non 1ilU NrllI1 ILl I ~Ijl I )11) ~In 1~llrl~111N PEllf))) IUD rio
1 TraJ rll n~~ LlGi-S ond Curricula
I
TranGfer lu ~Er when no longer needed for I reference trl perrnanently bull in the PRe I -
I
I I 2 All other HxlerJ31
Destroy ofter 3 yeorc
III PUBLICA1IONS EECORDS
These d oc uments relote to i he publ i catLon of ORS s t udae s such a s the E ( ~) 1bleG the MdLcare Data Serles and the Dlsab LIHy ApplJ cauls Statlstlcs Included are earner-a c)PY md nq=ot ive s of the pub li ca t a ona Forms IWil-26 Requ i s i t ron for Duplt ca t ing Phot ograprn ng and MJGcolJaneolJs Pi-oc e s s i ng GSA-lOO SSA Pr i nt ing Requ i s i t ron a nd e qut valent documents
A Documen l G l lttHlg toR amp S Notes
13 AI] Other 113borlal
Des t lOy a 11 (1 2 yeur c
IV ElJJLUATI()I AND JlEASllREHrJlIT SYTEH RECORDS
Ihe sc record arcumulrrt c rn r=valuoLlng a sample of lCCllt lclJuclLCl lL)l1S o l bas i c ESDI c La Lm8 The c La irns )112 rCllT__) I-PC( -) (lei -11111 no If related po Lr c i e s and prucellulJ nrC 1)1~Lil [sClveri TIle delta LS t iansfer r ed Irom ho cnd1 p~~ ~llr(~j J Forme CO-lJc) JMCase Codi ng unde r rT 111(1 Ii-t--llll 1_111f~lli 1 t 1rltl~llt CO-l125A mm JulJGCltIUl rUP[ ~ll~ -J-Ci)YJ l()1 fJdL1 rind Ce ne r-aL and equ r vnIr-n [Jrlllf I (I llUlchcltt]J ~1l(1then to lnpc from Fll~(~l I pr od uc eo t rbu lu t od 1LgtlulC Tnc Ludrd is F01111 ~Sj-l)W~ tH~ C1se Cllllemiddotl llcci ul11lth 1 lhe mean
cout ro I ]01 re]I T_llPllClll III ~ll h 1r1t2LlGCce Lec i ell [(11 GLlrllpl ~lll~ II l ~ upla l u w 1 th I1U l 11 i onc u [ develop-mCEI )L cuc h cn~) u id ~c ClJJ-cl1cclcd 1ColllGt the da t a h(l( 11I(hcU]IIllW hnrlcl~rIS1IcG o I i he ClCG SSll-J40 l lll ( J I JJld
Faul (op bullbullbull huluding oiSJinal to b bullbull uInutlud 10 the Nal10nul Archive and Record SIVIC jf-- 50~8-2 GPo
- I
1H 111111 I I ~II - r 1 r I bull I I ) I J I r I r I ru I ~ r bull I I ~ I [ 11I
1 Ill 1 H
RLQlJCGl fuR i~-UTHJf(I1r TO DISPOSr OF ruCOfDS-Conlinuulioll Dht-ei
-------------------_ ---- --- _ _
[I III I I II I 101J 1- III 1 ~I 10
rif1 r (I LM 1lt) 11 I~ Ll1middot rv tll )11 11II() I r hlL~) JOII 110 ~Ll hl~ 1~XlN
1
Iho l a bu Ln _ed Li u I Illr~J are uccd to prepare reporL s wh i c h ] CC1VET Inct ors or f~Dl ent i t Lement and whi ch analyze the i c or-r-ec t ne cc of t he OrLL3-Lnalfinding These rf~purts I 1nc Lixle
I
A ~cl1nallnual Repurt i
Plellllllllary Dd a on Pol icles and Procedures ReC8rdlnlt lillt lal En I tlemellL Lo R3DI BellefJts I
I
Peporl on rOllC1CS and Procedures f(lr Jmiddottabl-Lslung 1111 I -La Ent J Llemltni I u R3DI BcnefllJ
RePIJlLc i aued 83 requested by other bureaus and office) on such s~)Jects as ieleserv-Lce and rp])rc3enl311 10 pewees
] and Tabulated
Irn nrfer t c the SSA Holding Area lftr~r ] year Ii-anc Ie r to 111p FRC after 2 yea r-s Destroy nftEr 3 jl(arc lE1ClltlOll in the 1RC
2III Deatr ov 0IlClnal documerit s after uu cr-otr Im h~s I bcen pi-oven a cce pt abl e Retu i n rmcro ta Im ~~ 1
I e- 1Jt1cftJJt_li ~7 c2~- I a~ ~~ I~~---c-b~~ p-a~ ~-t~ ~~~I ) celnwnnml neprt a~ u--~ I lII~tluy alt I~l P b l icut r on 111 unnua L report [
ll1Llrll ~~(P)II 11l pcj n1 HTC1ti ] I
I I V ~laquo~~IlIIll ~l t Pl1Wllj(~ll-1jI I
v
FOUT COPIC1I Inc JUWIUI oglnol 0 bo ubllitt~d 10 Iho NahonaJ Jlrchea and Record Serlco lO-594JR-l GPO
(
J I i1a t ~1 I~~~~III I f I I bull 1~I
Ij I I 1 11
lEUU ClIOpound- AUTBOlIT 1 TO DISPOGB OF mCORm ---ConHnult1lion S11cet
7 1 III 1IIfl)N Of III ~1 I In ()I~11pound 11 NO Ilill l(LUIL [JAIl J ) hi IHfI(d1l It~) In) -11 t r i lOtI I rKf Nj(JIl foiL)
I Iut i La ti ec communfcat i ons t ranspor-t at aon custoclJal~
or oiher serVlces requlred by an offlcej and to the i generol mai nt enunce of an offLc e These records I
include but are not Lumt ed to I
1 Requests for supplies recelpts for supplIes i and equipment requests for djsposal of I equr pment and s uruIn r papers pe rt a Irn ng to offlce supply matters
Destroy after 2 years
2 Requests for pub Lr cat acns and hLank fJnos and other paper-s related to the supply and rhstll-b ut i on uf pub l i cat i ons to Lhe o IIace
Destroy a~ter 2 years
3 Documenlo related to local t rans poi-La t ion and
c us t od iu L ae rv rc e required by an o ffr ce
Destroy after 2 years
4 Requo cts for tnata l Int t on of t-elephones telephone ext ens ionc reques tc for change to Le Le phone d rrcct orres and s mu Lar pa per-s
Destroy after 2 yeo r-o
5 DOClUIlenL G related to ORS par-t rcapat Lon l11 cha r i table a Ifa i r-s such as t he annual Combined Federol Cltlmpalgn
Dosiroy ufLer 2 yeors
6 Documcnts ltlflLed l o bur Ld i ng Iac t Li Lies cuch ac rlour pJ~JIG space surveys reports of need 11)1 idl 1 I LOllClI SJX1CC and r-e Latcd correspolldence
Dc ~j l rr)y Ii Hl1 no 1ltrJ1fr n~ccl od 101 ll fer~nce or (1(111-11 n c lLv t i v L~ cornpleted bull
lll-~t- (l)lUYWlJI Co relate to employee health pr ojec t c SUC]l rlC b l oori 110nai r ons prevent r on shots and rc Lu t t~c1 cU]le~JP()llllell e Irie Luded LJ Fo rm T1EH-516
roar copi~s ioClucbng onglnal to be lIubnuUed to tho Notional Archivos and Rocold Selvico 10- 50middottm-~ GPO
41JIIHflIfl J 11111 0 I tlU
I I I L 1)11111
I ~ I 1 r t I ( r 1 I ~ 1 I 1 dl r ~ I I I 1 I
L~JX)iJLSTrOR IUTlIOHITY 10 DISPOZir or HrCORD8--ConHmlC1tion Sheet
----------- ----- -------- -------- - - ----~----------------------__-__-- ----I 10
l 11 r~() r ION r frN
Acc iderrt Report wluch Hi a quarterly report of all accldenLs occurrlng In DRS
1 Form HEhl- 516
Dest roy aft er 1 year
2 All Other MlterJ al
I Destroy l~ months after occur renee of the ) act Ivi i y
C Report of Luss or Theft
Thu reco rd cons ret s of GSA Form 182 Rep)rL of LJSS or Theft which is prepared after these occurrences
Destroy art (01 4 months
D Records DLSI)OSJilon Records
Iho sc doc umentc rp[h~ct the 10caL1011 a nd Zcr dJSpOGLf ron of rlt(~utrIs retued or transferred out of an o IfLce to the FRe 01 to the SSA Records Ilo Ld i ng Area Included a 1 Forms )F-135 Re corde Iransnu t Lal and TIece i pt SSA- 325 SSA Records Iransnu i tal f~SA-32j Request to Transfer or Djspse 01 HlLerlal Jl1 SA Records Holding Area o I1d t he lr e q11Lva Le nt c bull
De s t i-oy Vl1(=n alJ rtocrrls rcfl(=c1rd on t he Li at lIrfo hcr-n d i s posed n[
l
J~romJJI s part LCl]XltLOn 111 VCUJ_01JS-ret LnJn[ procrcnn 1)lt 11 a c glA fJrnIDE ACI~ Upward fk)1) J I ) 1 y md 3l3 fC l(vel_JplIlent Iuc Ludcd are c11_ ~ll f ~llflnnu IJt~) n1en-eC 11s[ G forwarded 1)y r[llcf 1 oni l Jri-f 1 Lui JOllS and reJaf ed cor-re sponden e be t wetn CJOlliUKltO- Also Lnc Lud=d are Forms m1_ ))0 ln1llll11g TIIqueland Author-r za l Lon llEh1-737
r 11lt0( Yfcltnd3are ucc umulrrt rd I n nc1I1lll1Lsiering ORS
Foul Coplesectl including ongtnal to be submitted to e National II1chive and Records SOlvhe
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
bullbull L
~C1tdlJld J flllll in rr-a II I 1 IJ lr 4I Ie II I ~ I I I l I I I II 1111 Jolgt No Pi~middot - J I I
p-rQUCST FOI- lUTHORITY TO DISPOSE OF RECORDS--ConHnuC1tion Shoet
10B I L IWII IN rf 11P 7 SJMPI L OH IT ~NO Ion NO111 I dCl ivt [)i11 I I I~ 1middot[ rrrlllOIl PC lun ) ACflOfJ rAKfll
B Tec]u1Lcal L1a1son Records
These documerrt c acc umuLate In mairrt a Ln I ng re La t i on-sh i ps be t ween SSA arid ant er-nat rona L soc ia L secur i t y organi~ail(mJ such as the Ent e rna t i ona L Labor Orgl111zat ron the Irrt er-nat i ona L Soclal Secur 1 ty As soc iat i on and the Inter-American Conference on 00clal Securliy Included are replles io inqulries and queat ronna i re s on US Cover-muorrt POllCY corres-pondence re La t J ng 10 appom+ments to commlt t e e c vrh ell research s pec Lfi c soc i aL se c ur-i ty prob Lemc de ve Lop que at ronna r rec and prepa re reports Also r nc I lldec1 are document s r-eLat ing Lo development of iielnot rona L a[reemeni s on soc i a L secur i t y such as correspondence bet1tlOen member-s of the nego t La l Lng t eam oIJLc i a L reports of meet i ngs co p re s of the Ii na L acreement 111terpretaiJ ens of the agreement and auZ11HllY agreement s The offLc ia L copy of t lie acreelilenl 1S mar nt a ined ln the Depar+ment of Stale
1 Repl1cs 10 Inqu1rles and Questionnaires
Destroy af~er 3 years
2 Corrmuttee ApPoln111Ient Correspondence
Destroy aftc r ~~yorrrs
3 DoclunellLr Rclni1ng to International Agreements
I I I
Ic I
1lIr~J rlOCllJlJIIJl c 1cllunulaLt In DlraJl~lng 101 Lral11111g JI 1 IUnlf~ll mil i oni Ls 111 soc ia L ~AlULLy educat i ona I plUI_lllIlJ IJJIHjrd Cllt-~ Lis t c oLlllo~c pc ruons rcllr~d t ru r nr n cur r r cula and lt~lQle(1 currrsponc1en e (Il GI Lnch1ucd 111 dnCl~JI-llta cc mnulaled LIt pro vrd i ng lrchJ1J ci I 10 11 ll1l(~ j c) I he ACCllCY IUl JllLernal10nal lr_W]t1IJl_n tJr1 ul he r rlGencles lfCc11r1iJlG pa rame te rr _J 0_1gt1 AUUll i I (~CblnCal llef-c111 dcvc l oping (~U1D 11 r and (~OlI(fJJ)(JllUc1tleL)(lll 01 her count i-i cs rr]t lll t) I lie i r lHeclJ
---__----------------__--------IfI-bU42R3 GPOFon copie includang onginal 10b subnutted to the Natiopul Archive Gndaecord Selvia
__
5
10
11
nd ud J PI 11 -41 Illft HI I Imiddotd r lit I I I I III II
L
I I I 11 No Ii H In
lltrQUIf~1 tOR AUTHORITY 10 DISPOSE or RICORDS--Continnaiion Shcrl
~--------------------- ----------__-------J
I fgtl )IPllor 01 1111 ~iI1II[( l non 1ilU NrllI1 ILl I ~Ijl I )11) ~In 1~llrl~111N PEllf))) IUD rio
1 TraJ rll n~~ LlGi-S ond Curricula
I
TranGfer lu ~Er when no longer needed for I reference trl perrnanently bull in the PRe I -
I
I I 2 All other HxlerJ31
Destroy ofter 3 yeorc
III PUBLICA1IONS EECORDS
These d oc uments relote to i he publ i catLon of ORS s t udae s such a s the E ( ~) 1bleG the MdLcare Data Serles and the Dlsab LIHy ApplJ cauls Statlstlcs Included are earner-a c)PY md nq=ot ive s of the pub li ca t a ona Forms IWil-26 Requ i s i t ron for Duplt ca t ing Phot ograprn ng and MJGcolJaneolJs Pi-oc e s s i ng GSA-lOO SSA Pr i nt ing Requ i s i t ron a nd e qut valent documents
A Documen l G l lttHlg toR amp S Notes
13 AI] Other 113borlal
Des t lOy a 11 (1 2 yeur c
IV ElJJLUATI()I AND JlEASllREHrJlIT SYTEH RECORDS
Ihe sc record arcumulrrt c rn r=valuoLlng a sample of lCCllt lclJuclLCl lL)l1S o l bas i c ESDI c La Lm8 The c La irns )112 rCllT__) I-PC( -) (lei -11111 no If related po Lr c i e s and prucellulJ nrC 1)1~Lil [sClveri TIle delta LS t iansfer r ed Irom ho cnd1 p~~ ~llr(~j J Forme CO-lJc) JMCase Codi ng unde r rT 111(1 Ii-t--llll 1_111f~lli 1 t 1rltl~llt CO-l125A mm JulJGCltIUl rUP[ ~ll~ -J-Ci)YJ l()1 fJdL1 rind Ce ne r-aL and equ r vnIr-n [Jrlllf I (I llUlchcltt]J ~1l(1then to lnpc from Fll~(~l I pr od uc eo t rbu lu t od 1LgtlulC Tnc Ludrd is F01111 ~Sj-l)W~ tH~ C1se Cllllemiddotl llcci ul11lth 1 lhe mean
cout ro I ]01 re]I T_llPllClll III ~ll h 1r1t2LlGCce Lec i ell [(11 GLlrllpl ~lll~ II l ~ upla l u w 1 th I1U l 11 i onc u [ develop-mCEI )L cuc h cn~) u id ~c ClJJ-cl1cclcd 1ColllGt the da t a h(l( 11I(hcU]IIllW hnrlcl~rIS1IcG o I i he ClCG SSll-J40 l lll ( J I JJld
Faul (op bullbullbull huluding oiSJinal to b bullbull uInutlud 10 the Nal10nul Archive and Record SIVIC jf-- 50~8-2 GPo
- I
1H 111111 I I ~II - r 1 r I bull I I ) I J I r I r I ru I ~ r bull I I ~ I [ 11I
1 Ill 1 H
RLQlJCGl fuR i~-UTHJf(I1r TO DISPOSr OF ruCOfDS-Conlinuulioll Dht-ei
-------------------_ ---- --- _ _
[I III I I II I 101J 1- III 1 ~I 10
rif1 r (I LM 1lt) 11 I~ Ll1middot rv tll )11 11II() I r hlL~) JOII 110 ~Ll hl~ 1~XlN
1
Iho l a bu Ln _ed Li u I Illr~J are uccd to prepare reporL s wh i c h ] CC1VET Inct ors or f~Dl ent i t Lement and whi ch analyze the i c or-r-ec t ne cc of t he OrLL3-Lnalfinding These rf~purts I 1nc Lixle
I
A ~cl1nallnual Repurt i
Plellllllllary Dd a on Pol icles and Procedures ReC8rdlnlt lillt lal En I tlemellL Lo R3DI BellefJts I
I
Peporl on rOllC1CS and Procedures f(lr Jmiddottabl-Lslung 1111 I -La Ent J Llemltni I u R3DI BcnefllJ
RePIJlLc i aued 83 requested by other bureaus and office) on such s~)Jects as ieleserv-Lce and rp])rc3enl311 10 pewees
] and Tabulated
Irn nrfer t c the SSA Holding Area lftr~r ] year Ii-anc Ie r to 111p FRC after 2 yea r-s Destroy nftEr 3 jl(arc lE1ClltlOll in the 1RC
2III Deatr ov 0IlClnal documerit s after uu cr-otr Im h~s I bcen pi-oven a cce pt abl e Retu i n rmcro ta Im ~~ 1
I e- 1Jt1cftJJt_li ~7 c2~- I a~ ~~ I~~---c-b~~ p-a~ ~-t~ ~~~I ) celnwnnml neprt a~ u--~ I lII~tluy alt I~l P b l icut r on 111 unnua L report [
ll1Llrll ~~(P)II 11l pcj n1 HTC1ti ] I
I I V ~laquo~~IlIIll ~l t Pl1Wllj(~ll-1jI I
v
FOUT COPIC1I Inc JUWIUI oglnol 0 bo ubllitt~d 10 Iho NahonaJ Jlrchea and Record Serlco lO-594JR-l GPO
(
J I i1a t ~1 I~~~~III I f I I bull 1~I
Ij I I 1 11
lEUU ClIOpound- AUTBOlIT 1 TO DISPOGB OF mCORm ---ConHnult1lion S11cet
7 1 III 1IIfl)N Of III ~1 I In ()I~11pound 11 NO Ilill l(LUIL [JAIl J ) hi IHfI(d1l It~) In) -11 t r i lOtI I rKf Nj(JIl foiL)
I Iut i La ti ec communfcat i ons t ranspor-t at aon custoclJal~
or oiher serVlces requlred by an offlcej and to the i generol mai nt enunce of an offLc e These records I
include but are not Lumt ed to I
1 Requests for supplies recelpts for supplIes i and equipment requests for djsposal of I equr pment and s uruIn r papers pe rt a Irn ng to offlce supply matters
Destroy after 2 years
2 Requests for pub Lr cat acns and hLank fJnos and other paper-s related to the supply and rhstll-b ut i on uf pub l i cat i ons to Lhe o IIace
Destroy a~ter 2 years
3 Documenlo related to local t rans poi-La t ion and
c us t od iu L ae rv rc e required by an o ffr ce
Destroy after 2 years
4 Requo cts for tnata l Int t on of t-elephones telephone ext ens ionc reques tc for change to Le Le phone d rrcct orres and s mu Lar pa per-s
Destroy after 2 yeo r-o
5 DOClUIlenL G related to ORS par-t rcapat Lon l11 cha r i table a Ifa i r-s such as t he annual Combined Federol Cltlmpalgn
Dosiroy ufLer 2 yeors
6 Documcnts ltlflLed l o bur Ld i ng Iac t Li Lies cuch ac rlour pJ~JIG space surveys reports of need 11)1 idl 1 I LOllClI SJX1CC and r-e Latcd correspolldence
Dc ~j l rr)y Ii Hl1 no 1ltrJ1fr n~ccl od 101 ll fer~nce or (1(111-11 n c lLv t i v L~ cornpleted bull
lll-~t- (l)lUYWlJI Co relate to employee health pr ojec t c SUC]l rlC b l oori 110nai r ons prevent r on shots and rc Lu t t~c1 cU]le~JP()llllell e Irie Luded LJ Fo rm T1EH-516
roar copi~s ioClucbng onglnal to be lIubnuUed to tho Notional Archivos and Rocold Selvico 10- 50middottm-~ GPO
41JIIHflIfl J 11111 0 I tlU
I I I L 1)11111
I ~ I 1 r t I ( r 1 I ~ 1 I 1 dl r ~ I I I 1 I
L~JX)iJLSTrOR IUTlIOHITY 10 DISPOZir or HrCORD8--ConHmlC1tion Sheet
----------- ----- -------- -------- - - ----~----------------------__-__-- ----I 10
l 11 r~() r ION r frN
Acc iderrt Report wluch Hi a quarterly report of all accldenLs occurrlng In DRS
1 Form HEhl- 516
Dest roy aft er 1 year
2 All Other MlterJ al
I Destroy l~ months after occur renee of the ) act Ivi i y
C Report of Luss or Theft
Thu reco rd cons ret s of GSA Form 182 Rep)rL of LJSS or Theft which is prepared after these occurrences
Destroy art (01 4 months
D Records DLSI)OSJilon Records
Iho sc doc umentc rp[h~ct the 10caL1011 a nd Zcr dJSpOGLf ron of rlt(~utrIs retued or transferred out of an o IfLce to the FRe 01 to the SSA Records Ilo Ld i ng Area Included a 1 Forms )F-135 Re corde Iransnu t Lal and TIece i pt SSA- 325 SSA Records Iransnu i tal f~SA-32j Request to Transfer or Djspse 01 HlLerlal Jl1 SA Records Holding Area o I1d t he lr e q11Lva Le nt c bull
De s t i-oy Vl1(=n alJ rtocrrls rcfl(=c1rd on t he Li at lIrfo hcr-n d i s posed n[
l
J~romJJI s part LCl]XltLOn 111 VCUJ_01JS-ret LnJn[ procrcnn 1)lt 11 a c glA fJrnIDE ACI~ Upward fk)1) J I ) 1 y md 3l3 fC l(vel_JplIlent Iuc Ludcd are c11_ ~ll f ~llflnnu IJt~) n1en-eC 11s[ G forwarded 1)y r[llcf 1 oni l Jri-f 1 Lui JOllS and reJaf ed cor-re sponden e be t wetn CJOlliUKltO- Also Lnc Lud=d are Forms m1_ ))0 ln1llll11g TIIqueland Author-r za l Lon llEh1-737
r 11lt0( Yfcltnd3are ucc umulrrt rd I n nc1I1lll1Lsiering ORS
Foul Coplesectl including ongtnal to be submitted to e National II1chive and Records SOlvhe
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
__
5
10
11
nd ud J PI 11 -41 Illft HI I Imiddotd r lit I I I I III II
L
I I I 11 No Ii H In
lltrQUIf~1 tOR AUTHORITY 10 DISPOSE or RICORDS--Continnaiion Shcrl
~--------------------- ----------__-------J
I fgtl )IPllor 01 1111 ~iI1II[( l non 1ilU NrllI1 ILl I ~Ijl I )11) ~In 1~llrl~111N PEllf))) IUD rio
1 TraJ rll n~~ LlGi-S ond Curricula
I
TranGfer lu ~Er when no longer needed for I reference trl perrnanently bull in the PRe I -
I
I I 2 All other HxlerJ31
Destroy ofter 3 yeorc
III PUBLICA1IONS EECORDS
These d oc uments relote to i he publ i catLon of ORS s t udae s such a s the E ( ~) 1bleG the MdLcare Data Serles and the Dlsab LIHy ApplJ cauls Statlstlcs Included are earner-a c)PY md nq=ot ive s of the pub li ca t a ona Forms IWil-26 Requ i s i t ron for Duplt ca t ing Phot ograprn ng and MJGcolJaneolJs Pi-oc e s s i ng GSA-lOO SSA Pr i nt ing Requ i s i t ron a nd e qut valent documents
A Documen l G l lttHlg toR amp S Notes
13 AI] Other 113borlal
Des t lOy a 11 (1 2 yeur c
IV ElJJLUATI()I AND JlEASllREHrJlIT SYTEH RECORDS
Ihe sc record arcumulrrt c rn r=valuoLlng a sample of lCCllt lclJuclLCl lL)l1S o l bas i c ESDI c La Lm8 The c La irns )112 rCllT__) I-PC( -) (lei -11111 no If related po Lr c i e s and prucellulJ nrC 1)1~Lil [sClveri TIle delta LS t iansfer r ed Irom ho cnd1 p~~ ~llr(~j J Forme CO-lJc) JMCase Codi ng unde r rT 111(1 Ii-t--llll 1_111f~lli 1 t 1rltl~llt CO-l125A mm JulJGCltIUl rUP[ ~ll~ -J-Ci)YJ l()1 fJdL1 rind Ce ne r-aL and equ r vnIr-n [Jrlllf I (I llUlchcltt]J ~1l(1then to lnpc from Fll~(~l I pr od uc eo t rbu lu t od 1LgtlulC Tnc Ludrd is F01111 ~Sj-l)W~ tH~ C1se Cllllemiddotl llcci ul11lth 1 lhe mean
cout ro I ]01 re]I T_llPllClll III ~ll h 1r1t2LlGCce Lec i ell [(11 GLlrllpl ~lll~ II l ~ upla l u w 1 th I1U l 11 i onc u [ develop-mCEI )L cuc h cn~) u id ~c ClJJ-cl1cclcd 1ColllGt the da t a h(l( 11I(hcU]IIllW hnrlcl~rIS1IcG o I i he ClCG SSll-J40 l lll ( J I JJld
Faul (op bullbullbull huluding oiSJinal to b bullbull uInutlud 10 the Nal10nul Archive and Record SIVIC jf-- 50~8-2 GPo
- I
1H 111111 I I ~II - r 1 r I bull I I ) I J I r I r I ru I ~ r bull I I ~ I [ 11I
1 Ill 1 H
RLQlJCGl fuR i~-UTHJf(I1r TO DISPOSr OF ruCOfDS-Conlinuulioll Dht-ei
-------------------_ ---- --- _ _
[I III I I II I 101J 1- III 1 ~I 10
rif1 r (I LM 1lt) 11 I~ Ll1middot rv tll )11 11II() I r hlL~) JOII 110 ~Ll hl~ 1~XlN
1
Iho l a bu Ln _ed Li u I Illr~J are uccd to prepare reporL s wh i c h ] CC1VET Inct ors or f~Dl ent i t Lement and whi ch analyze the i c or-r-ec t ne cc of t he OrLL3-Lnalfinding These rf~purts I 1nc Lixle
I
A ~cl1nallnual Repurt i
Plellllllllary Dd a on Pol icles and Procedures ReC8rdlnlt lillt lal En I tlemellL Lo R3DI BellefJts I
I
Peporl on rOllC1CS and Procedures f(lr Jmiddottabl-Lslung 1111 I -La Ent J Llemltni I u R3DI BcnefllJ
RePIJlLc i aued 83 requested by other bureaus and office) on such s~)Jects as ieleserv-Lce and rp])rc3enl311 10 pewees
] and Tabulated
Irn nrfer t c the SSA Holding Area lftr~r ] year Ii-anc Ie r to 111p FRC after 2 yea r-s Destroy nftEr 3 jl(arc lE1ClltlOll in the 1RC
2III Deatr ov 0IlClnal documerit s after uu cr-otr Im h~s I bcen pi-oven a cce pt abl e Retu i n rmcro ta Im ~~ 1
I e- 1Jt1cftJJt_li ~7 c2~- I a~ ~~ I~~---c-b~~ p-a~ ~-t~ ~~~I ) celnwnnml neprt a~ u--~ I lII~tluy alt I~l P b l icut r on 111 unnua L report [
ll1Llrll ~~(P)II 11l pcj n1 HTC1ti ] I
I I V ~laquo~~IlIIll ~l t Pl1Wllj(~ll-1jI I
v
FOUT COPIC1I Inc JUWIUI oglnol 0 bo ubllitt~d 10 Iho NahonaJ Jlrchea and Record Serlco lO-594JR-l GPO
(
J I i1a t ~1 I~~~~III I f I I bull 1~I
Ij I I 1 11
lEUU ClIOpound- AUTBOlIT 1 TO DISPOGB OF mCORm ---ConHnult1lion S11cet
7 1 III 1IIfl)N Of III ~1 I In ()I~11pound 11 NO Ilill l(LUIL [JAIl J ) hi IHfI(d1l It~) In) -11 t r i lOtI I rKf Nj(JIl foiL)
I Iut i La ti ec communfcat i ons t ranspor-t at aon custoclJal~
or oiher serVlces requlred by an offlcej and to the i generol mai nt enunce of an offLc e These records I
include but are not Lumt ed to I
1 Requests for supplies recelpts for supplIes i and equipment requests for djsposal of I equr pment and s uruIn r papers pe rt a Irn ng to offlce supply matters
Destroy after 2 years
2 Requests for pub Lr cat acns and hLank fJnos and other paper-s related to the supply and rhstll-b ut i on uf pub l i cat i ons to Lhe o IIace
Destroy a~ter 2 years
3 Documenlo related to local t rans poi-La t ion and
c us t od iu L ae rv rc e required by an o ffr ce
Destroy after 2 years
4 Requo cts for tnata l Int t on of t-elephones telephone ext ens ionc reques tc for change to Le Le phone d rrcct orres and s mu Lar pa per-s
Destroy after 2 yeo r-o
5 DOClUIlenL G related to ORS par-t rcapat Lon l11 cha r i table a Ifa i r-s such as t he annual Combined Federol Cltlmpalgn
Dosiroy ufLer 2 yeors
6 Documcnts ltlflLed l o bur Ld i ng Iac t Li Lies cuch ac rlour pJ~JIG space surveys reports of need 11)1 idl 1 I LOllClI SJX1CC and r-e Latcd correspolldence
Dc ~j l rr)y Ii Hl1 no 1ltrJ1fr n~ccl od 101 ll fer~nce or (1(111-11 n c lLv t i v L~ cornpleted bull
lll-~t- (l)lUYWlJI Co relate to employee health pr ojec t c SUC]l rlC b l oori 110nai r ons prevent r on shots and rc Lu t t~c1 cU]le~JP()llllell e Irie Luded LJ Fo rm T1EH-516
roar copi~s ioClucbng onglnal to be lIubnuUed to tho Notional Archivos and Rocold Selvico 10- 50middottm-~ GPO
41JIIHflIfl J 11111 0 I tlU
I I I L 1)11111
I ~ I 1 r t I ( r 1 I ~ 1 I 1 dl r ~ I I I 1 I
L~JX)iJLSTrOR IUTlIOHITY 10 DISPOZir or HrCORD8--ConHmlC1tion Sheet
----------- ----- -------- -------- - - ----~----------------------__-__-- ----I 10
l 11 r~() r ION r frN
Acc iderrt Report wluch Hi a quarterly report of all accldenLs occurrlng In DRS
1 Form HEhl- 516
Dest roy aft er 1 year
2 All Other MlterJ al
I Destroy l~ months after occur renee of the ) act Ivi i y
C Report of Luss or Theft
Thu reco rd cons ret s of GSA Form 182 Rep)rL of LJSS or Theft which is prepared after these occurrences
Destroy art (01 4 months
D Records DLSI)OSJilon Records
Iho sc doc umentc rp[h~ct the 10caL1011 a nd Zcr dJSpOGLf ron of rlt(~utrIs retued or transferred out of an o IfLce to the FRe 01 to the SSA Records Ilo Ld i ng Area Included a 1 Forms )F-135 Re corde Iransnu t Lal and TIece i pt SSA- 325 SSA Records Iransnu i tal f~SA-32j Request to Transfer or Djspse 01 HlLerlal Jl1 SA Records Holding Area o I1d t he lr e q11Lva Le nt c bull
De s t i-oy Vl1(=n alJ rtocrrls rcfl(=c1rd on t he Li at lIrfo hcr-n d i s posed n[
l
J~romJJI s part LCl]XltLOn 111 VCUJ_01JS-ret LnJn[ procrcnn 1)lt 11 a c glA fJrnIDE ACI~ Upward fk)1) J I ) 1 y md 3l3 fC l(vel_JplIlent Iuc Ludcd are c11_ ~ll f ~llflnnu IJt~) n1en-eC 11s[ G forwarded 1)y r[llcf 1 oni l Jri-f 1 Lui JOllS and reJaf ed cor-re sponden e be t wetn CJOlliUKltO- Also Lnc Lud=d are Forms m1_ ))0 ln1llll11g TIIqueland Author-r za l Lon llEh1-737
r 11lt0( Yfcltnd3are ucc umulrrt rd I n nc1I1lll1Lsiering ORS
Foul Coplesectl including ongtnal to be submitted to e National II1chive and Records SOlvhe
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
- I
1H 111111 I I ~II - r 1 r I bull I I ) I J I r I r I ru I ~ r bull I I ~ I [ 11I
1 Ill 1 H
RLQlJCGl fuR i~-UTHJf(I1r TO DISPOSr OF ruCOfDS-Conlinuulioll Dht-ei
-------------------_ ---- --- _ _
[I III I I II I 101J 1- III 1 ~I 10
rif1 r (I LM 1lt) 11 I~ Ll1middot rv tll )11 11II() I r hlL~) JOII 110 ~Ll hl~ 1~XlN
1
Iho l a bu Ln _ed Li u I Illr~J are uccd to prepare reporL s wh i c h ] CC1VET Inct ors or f~Dl ent i t Lement and whi ch analyze the i c or-r-ec t ne cc of t he OrLL3-Lnalfinding These rf~purts I 1nc Lixle
I
A ~cl1nallnual Repurt i
Plellllllllary Dd a on Pol icles and Procedures ReC8rdlnlt lillt lal En I tlemellL Lo R3DI BellefJts I
I
Peporl on rOllC1CS and Procedures f(lr Jmiddottabl-Lslung 1111 I -La Ent J Llemltni I u R3DI BcnefllJ
RePIJlLc i aued 83 requested by other bureaus and office) on such s~)Jects as ieleserv-Lce and rp])rc3enl311 10 pewees
] and Tabulated
Irn nrfer t c the SSA Holding Area lftr~r ] year Ii-anc Ie r to 111p FRC after 2 yea r-s Destroy nftEr 3 jl(arc lE1ClltlOll in the 1RC
2III Deatr ov 0IlClnal documerit s after uu cr-otr Im h~s I bcen pi-oven a cce pt abl e Retu i n rmcro ta Im ~~ 1
I e- 1Jt1cftJJt_li ~7 c2~- I a~ ~~ I~~---c-b~~ p-a~ ~-t~ ~~~I ) celnwnnml neprt a~ u--~ I lII~tluy alt I~l P b l icut r on 111 unnua L report [
ll1Llrll ~~(P)II 11l pcj n1 HTC1ti ] I
I I V ~laquo~~IlIIll ~l t Pl1Wllj(~ll-1jI I
v
FOUT COPIC1I Inc JUWIUI oglnol 0 bo ubllitt~d 10 Iho NahonaJ Jlrchea and Record Serlco lO-594JR-l GPO
(
J I i1a t ~1 I~~~~III I f I I bull 1~I
Ij I I 1 11
lEUU ClIOpound- AUTBOlIT 1 TO DISPOGB OF mCORm ---ConHnult1lion S11cet
7 1 III 1IIfl)N Of III ~1 I In ()I~11pound 11 NO Ilill l(LUIL [JAIl J ) hi IHfI(d1l It~) In) -11 t r i lOtI I rKf Nj(JIl foiL)
I Iut i La ti ec communfcat i ons t ranspor-t at aon custoclJal~
or oiher serVlces requlred by an offlcej and to the i generol mai nt enunce of an offLc e These records I
include but are not Lumt ed to I
1 Requests for supplies recelpts for supplIes i and equipment requests for djsposal of I equr pment and s uruIn r papers pe rt a Irn ng to offlce supply matters
Destroy after 2 years
2 Requests for pub Lr cat acns and hLank fJnos and other paper-s related to the supply and rhstll-b ut i on uf pub l i cat i ons to Lhe o IIace
Destroy a~ter 2 years
3 Documenlo related to local t rans poi-La t ion and
c us t od iu L ae rv rc e required by an o ffr ce
Destroy after 2 years
4 Requo cts for tnata l Int t on of t-elephones telephone ext ens ionc reques tc for change to Le Le phone d rrcct orres and s mu Lar pa per-s
Destroy after 2 yeo r-o
5 DOClUIlenL G related to ORS par-t rcapat Lon l11 cha r i table a Ifa i r-s such as t he annual Combined Federol Cltlmpalgn
Dosiroy ufLer 2 yeors
6 Documcnts ltlflLed l o bur Ld i ng Iac t Li Lies cuch ac rlour pJ~JIG space surveys reports of need 11)1 idl 1 I LOllClI SJX1CC and r-e Latcd correspolldence
Dc ~j l rr)y Ii Hl1 no 1ltrJ1fr n~ccl od 101 ll fer~nce or (1(111-11 n c lLv t i v L~ cornpleted bull
lll-~t- (l)lUYWlJI Co relate to employee health pr ojec t c SUC]l rlC b l oori 110nai r ons prevent r on shots and rc Lu t t~c1 cU]le~JP()llllell e Irie Luded LJ Fo rm T1EH-516
roar copi~s ioClucbng onglnal to be lIubnuUed to tho Notional Archivos and Rocold Selvico 10- 50middottm-~ GPO
41JIIHflIfl J 11111 0 I tlU
I I I L 1)11111
I ~ I 1 r t I ( r 1 I ~ 1 I 1 dl r ~ I I I 1 I
L~JX)iJLSTrOR IUTlIOHITY 10 DISPOZir or HrCORD8--ConHmlC1tion Sheet
----------- ----- -------- -------- - - ----~----------------------__-__-- ----I 10
l 11 r~() r ION r frN
Acc iderrt Report wluch Hi a quarterly report of all accldenLs occurrlng In DRS
1 Form HEhl- 516
Dest roy aft er 1 year
2 All Other MlterJ al
I Destroy l~ months after occur renee of the ) act Ivi i y
C Report of Luss or Theft
Thu reco rd cons ret s of GSA Form 182 Rep)rL of LJSS or Theft which is prepared after these occurrences
Destroy art (01 4 months
D Records DLSI)OSJilon Records
Iho sc doc umentc rp[h~ct the 10caL1011 a nd Zcr dJSpOGLf ron of rlt(~utrIs retued or transferred out of an o IfLce to the FRe 01 to the SSA Records Ilo Ld i ng Area Included a 1 Forms )F-135 Re corde Iransnu t Lal and TIece i pt SSA- 325 SSA Records Iransnu i tal f~SA-32j Request to Transfer or Djspse 01 HlLerlal Jl1 SA Records Holding Area o I1d t he lr e q11Lva Le nt c bull
De s t i-oy Vl1(=n alJ rtocrrls rcfl(=c1rd on t he Li at lIrfo hcr-n d i s posed n[
l
J~romJJI s part LCl]XltLOn 111 VCUJ_01JS-ret LnJn[ procrcnn 1)lt 11 a c glA fJrnIDE ACI~ Upward fk)1) J I ) 1 y md 3l3 fC l(vel_JplIlent Iuc Ludcd are c11_ ~ll f ~llflnnu IJt~) n1en-eC 11s[ G forwarded 1)y r[llcf 1 oni l Jri-f 1 Lui JOllS and reJaf ed cor-re sponden e be t wetn CJOlliUKltO- Also Lnc Lud=d are Forms m1_ ))0 ln1llll11g TIIqueland Author-r za l Lon llEh1-737
r 11lt0( Yfcltnd3are ucc umulrrt rd I n nc1I1lll1Lsiering ORS
Foul Coplesectl including ongtnal to be submitted to e National II1chive and Records SOlvhe
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
(
J I i1a t ~1 I~~~~III I f I I bull 1~I
Ij I I 1 11
lEUU ClIOpound- AUTBOlIT 1 TO DISPOGB OF mCORm ---ConHnult1lion S11cet
7 1 III 1IIfl)N Of III ~1 I In ()I~11pound 11 NO Ilill l(LUIL [JAIl J ) hi IHfI(d1l It~) In) -11 t r i lOtI I rKf Nj(JIl foiL)
I Iut i La ti ec communfcat i ons t ranspor-t at aon custoclJal~
or oiher serVlces requlred by an offlcej and to the i generol mai nt enunce of an offLc e These records I
include but are not Lumt ed to I
1 Requests for supplies recelpts for supplIes i and equipment requests for djsposal of I equr pment and s uruIn r papers pe rt a Irn ng to offlce supply matters
Destroy after 2 years
2 Requests for pub Lr cat acns and hLank fJnos and other paper-s related to the supply and rhstll-b ut i on uf pub l i cat i ons to Lhe o IIace
Destroy a~ter 2 years
3 Documenlo related to local t rans poi-La t ion and
c us t od iu L ae rv rc e required by an o ffr ce
Destroy after 2 years
4 Requo cts for tnata l Int t on of t-elephones telephone ext ens ionc reques tc for change to Le Le phone d rrcct orres and s mu Lar pa per-s
Destroy after 2 yeo r-o
5 DOClUIlenL G related to ORS par-t rcapat Lon l11 cha r i table a Ifa i r-s such as t he annual Combined Federol Cltlmpalgn
Dosiroy ufLer 2 yeors
6 Documcnts ltlflLed l o bur Ld i ng Iac t Li Lies cuch ac rlour pJ~JIG space surveys reports of need 11)1 idl 1 I LOllClI SJX1CC and r-e Latcd correspolldence
Dc ~j l rr)y Ii Hl1 no 1ltrJ1fr n~ccl od 101 ll fer~nce or (1(111-11 n c lLv t i v L~ cornpleted bull
lll-~t- (l)lUYWlJI Co relate to employee health pr ojec t c SUC]l rlC b l oori 110nai r ons prevent r on shots and rc Lu t t~c1 cU]le~JP()llllell e Irie Luded LJ Fo rm T1EH-516
roar copi~s ioClucbng onglnal to be lIubnuUed to tho Notional Archivos and Rocold Selvico 10- 50middottm-~ GPO
41JIIHflIfl J 11111 0 I tlU
I I I L 1)11111
I ~ I 1 r t I ( r 1 I ~ 1 I 1 dl r ~ I I I 1 I
L~JX)iJLSTrOR IUTlIOHITY 10 DISPOZir or HrCORD8--ConHmlC1tion Sheet
----------- ----- -------- -------- - - ----~----------------------__-__-- ----I 10
l 11 r~() r ION r frN
Acc iderrt Report wluch Hi a quarterly report of all accldenLs occurrlng In DRS
1 Form HEhl- 516
Dest roy aft er 1 year
2 All Other MlterJ al
I Destroy l~ months after occur renee of the ) act Ivi i y
C Report of Luss or Theft
Thu reco rd cons ret s of GSA Form 182 Rep)rL of LJSS or Theft which is prepared after these occurrences
Destroy art (01 4 months
D Records DLSI)OSJilon Records
Iho sc doc umentc rp[h~ct the 10caL1011 a nd Zcr dJSpOGLf ron of rlt(~utrIs retued or transferred out of an o IfLce to the FRe 01 to the SSA Records Ilo Ld i ng Area Included a 1 Forms )F-135 Re corde Iransnu t Lal and TIece i pt SSA- 325 SSA Records Iransnu i tal f~SA-32j Request to Transfer or Djspse 01 HlLerlal Jl1 SA Records Holding Area o I1d t he lr e q11Lva Le nt c bull
De s t i-oy Vl1(=n alJ rtocrrls rcfl(=c1rd on t he Li at lIrfo hcr-n d i s posed n[
l
J~romJJI s part LCl]XltLOn 111 VCUJ_01JS-ret LnJn[ procrcnn 1)lt 11 a c glA fJrnIDE ACI~ Upward fk)1) J I ) 1 y md 3l3 fC l(vel_JplIlent Iuc Ludcd are c11_ ~ll f ~llflnnu IJt~) n1en-eC 11s[ G forwarded 1)y r[llcf 1 oni l Jri-f 1 Lui JOllS and reJaf ed cor-re sponden e be t wetn CJOlliUKltO- Also Lnc Lud=d are Forms m1_ ))0 ln1llll11g TIIqueland Author-r za l Lon llEh1-737
r 11lt0( Yfcltnd3are ucc umulrrt rd I n nc1I1lll1Lsiering ORS
Foul Coplesectl including ongtnal to be submitted to e National II1chive and Records SOlvhe
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
41JIIHflIfl J 11111 0 I tlU
I I I L 1)11111
I ~ I 1 r t I ( r 1 I ~ 1 I 1 dl r ~ I I I 1 I
L~JX)iJLSTrOR IUTlIOHITY 10 DISPOZir or HrCORD8--ConHmlC1tion Sheet
----------- ----- -------- -------- - - ----~----------------------__-__-- ----I 10
l 11 r~() r ION r frN
Acc iderrt Report wluch Hi a quarterly report of all accldenLs occurrlng In DRS
1 Form HEhl- 516
Dest roy aft er 1 year
2 All Other MlterJ al
I Destroy l~ months after occur renee of the ) act Ivi i y
C Report of Luss or Theft
Thu reco rd cons ret s of GSA Form 182 Rep)rL of LJSS or Theft which is prepared after these occurrences
Destroy art (01 4 months
D Records DLSI)OSJilon Records
Iho sc doc umentc rp[h~ct the 10caL1011 a nd Zcr dJSpOGLf ron of rlt(~utrIs retued or transferred out of an o IfLce to the FRe 01 to the SSA Records Ilo Ld i ng Area Included a 1 Forms )F-135 Re corde Iransnu t Lal and TIece i pt SSA- 325 SSA Records Iransnu i tal f~SA-32j Request to Transfer or Djspse 01 HlLerlal Jl1 SA Records Holding Area o I1d t he lr e q11Lva Le nt c bull
De s t i-oy Vl1(=n alJ rtocrrls rcfl(=c1rd on t he Li at lIrfo hcr-n d i s posed n[
l
J~romJJI s part LCl]XltLOn 111 VCUJ_01JS-ret LnJn[ procrcnn 1)lt 11 a c glA fJrnIDE ACI~ Upward fk)1) J I ) 1 y md 3l3 fC l(vel_JplIlent Iuc Ludcd are c11_ ~ll f ~llflnnu IJt~) n1en-eC 11s[ G forwarded 1)y r[llcf 1 oni l Jri-f 1 Lui JOllS and reJaf ed cor-re sponden e be t wetn CJOlliUKltO- Also Lnc Lud=d are Forms m1_ ))0 ln1llll11g TIIqueland Author-r za l Lon llEh1-737
r 11lt0( Yfcltnd3are ucc umulrrt rd I n nc1I1lll1Lsiering ORS
Foul Coplesectl including ongtnal to be submitted to e National II1chive and Records SOlvhe
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
- It du111 I ( Ill 11 I t II ~ J J I I II
I - till 11 I III I I) No J a (t~ 9q)
t - I t I III 23 JlU
I
1 I I
H
I JJLtJ
ff
r~r ~I)II(Jr~
r[I_ liB
or 111- rt
lltlHJP)1 f tHUI~I) JI~r1JtLC r
JOiJ IV)
)1
ie TION [ irIf N
Aut 110)1 iza t ion for lr-ai n Lng J n Other Government Fac L 1Ll ie c arid equ 1 valent forme
Destroy a fLc r student leaves t he pro(jram
c
Destroy aft er leceipt of next Li s t bull
3 All 01 her Matenal
Destroy after 2 years
F
TIL(~L(~ doc ument c ac cumulate In the processing of I lvJld~ in i t urt ed by ORS such as high qua Lrt y l ncrr-n ce s rpec ra L a ch i evement s and sl~getlmls JJlchldpC are For-m 31-171 Reconnnendat ron for
1
I
I-Iurd and LI_gt equt voLe nt and related cor-res pondence I
De1 roy nILl 2 veur-c j
G (011=-1( RccruL lrwnL R((ords
I I
I Ihete rccortlj r nt er-ns fllt)nl
pel t ain tlt) rec rut tmr-nt vor Lour lU1J versltLes to
of managemen t-work in ORS
I j1r 1 ( to 1~_ jj1ullLll
CUll~ltP_)ndorultlot period Included are J]liS L0 the pr0irnlll and
I I I
q1J~SLJ()1ll1J1l(G dJHch so l i c i t the par t i c ipant t s I
(1_ t Lon I (J L 11_ pror-run
1(3( filer C-IlCgtlI ()J l~ql1lt-lt~tCl u)1Ler3 or Fo rm _~I-Lno ~)_[PrJlltJIW I~cqmlt I on a nd i t s f(1111V11 I1 bull
-- --- I --- - --- ---_ -- ---- -- ------ ------- ------
Four COpies inch-uung oligsnaJ to be uhanlttod to the National chvc and Record SClvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
I I bullbull
U un 41 I Imiddot Ill)l~ L
I t 11
1
11) 11 1 11
t 1 11 I
1 t
r 1 li1-I _10 f 23 [)(~l
7 I I I [ 11r)
n III l 11III n or III ~1 SftMPlEOP
lUG [H
q 10
fin InN lflKf_N
Ihusr CiOClUIlCllLsreLa t e t o the preparation of budgel prCljec l loric for ORS t he approved budget 8S well as 011 objectgt 0[ expenditures wh ich are cbarged atainGt the bndcet Tno Luded a re d ocumerrt s pe r+o Lning to each ob je c+ and aubob je et class of expe ndi t ur e s such as 110vel equipment printing re rrt a Lc a nd cupplle c 1I1s() LncLudud are cont ro L lEc1tElSthe rbnlhly Irunsac+Lou Report Listing and t rnve L records
1 Monthly rrr-1nsacilon ReJort Listing
Dec [roy a ft er 2 fiscal years
2 11101 h21 Mtterjal
Destroy after 3 fiscal years bull
eJ Payroll Rccords
These doc umen t s relate to OES expenditures for per sonne L LncLndr-d are lis ti ngs frori FinancLaL -hnaL~emenl 011 s uoh oG Pe i-cona L cervi~es and Be nc ILt c Expendltm Iia t u Fl~)w Bacl Common Account Lng Number and ()bj~ct Class SUlm1lary and Poyroll JransacLion Iot a Ls
Destroy nfter 2 flscal years
Ihos e 1CPHt ((Tlaln stallsi 1 CG on manpowe r and ~1It JJl i i (In- cuch QG -lvprl[~e Ircllle repo r t o and ll~ fclr-itdxl t~) Jiillal1cLul Hlilo~ImEnL OA
l)ll~je lTLIilrS CJl1~_IG l -lCrljll[~ coplcc empLoveer I l(C01c Iho 0 IrJ c inL copies
------_ ___-------
of oI ____ I _
Four copie inclucbpg orlqlnGl to bo ubrnitted 10 tho National Alchiwc Gild Recold Service 10--0428-2 GPo
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
~nlldld I 01 HI Hmiddot I 11
Ill d 11 11 Ill II 11 1 I~ ~ I I
HEQUUmiddotl rolaquo AUTHOIUry 10 DISPOSE or RECOHDS --ConLinuoion Sheet _---___-_ -_------ _---- -- --_ bull_ _---__-_ bull_- ---------__----_------_
il Il( 111IIiNI If-i1 111-T-d E nH 111110 I 1111 I ilLl 1 1) I rJ C~ f(l rI rlf ItYl pI illJr) rmiddotc n(jl~ rAIT~1 i
IOH NfJ
t he ae JCcorclc rue maLnt a lned in the otfl cLaL pe r conne 1 foI cl(~rc in 0 Peruonne 1 Included a re lur1(osof GF-52 bull Request for Per-sonne L Ac t Lon einploye e appraisals employee record cai-d s gtJltlun-rrode no t LfLca t Lonc reporLs of empLoyee Lnterview concerm ng r a t ang appra t sa L i and Job cond uc t j and s LmlLar documents pertainint to Jndi v idua L employees i
De s lroy in accordance with Append ix B Filing ReLent 10n Iab Le (Imployee Recorcls and Files) Clmplr~r r ~sGuide 1-4 Personnel Guide for Super1sJrs
2 POolt inll Dccr1ption Records
1110 recorr]consist of Opt ional Form e Fositjon 1l=script1on for each position 1n ems
D~tr)y _bsolcgtte pos i t Lon descriptions after ) yeare
3 Ferxmnel taffillg Records
Ihe s e recor1s coris Lat of documents re Lat Lng to piomot Lon of ems empLoycen such as lOIm
331-22 EequeGl for Ll s+ ~f Eliglble~ and Promot ion Lit-ingj vacancy announceme rrt c Heeldy and Monthly Reports 01 st a IILng acces s i onc and 108sMinor-Lty Employment Re po r-t ])repared by OA Personnel and equivalent doc umerrt o bull
Cl bull PllJmoiion Pockaee
Destruy after 2 years
Dcttmiddot ~([lel 1 cu r
I c I I lcpurt bullI I
i---_ ------- ---------- -----------Foul copiell inLluding ollgJluII 10 be Qubn1ilted to 1he Nahonol hehave and RCCtJEd SClvico
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
toIfulldlld 1111111 No IL~l~ -I I ~ l bull I I 1J I I i 1 II (IIIH) 111-1 11111 JI No 12I
- It T 1)1
rQLJTJl [OR AUlHOi-U1Y TO DISPOSr or RlcomS---GoI11inuolkm Sl~d
11[[1 110
II 11 c lIllmor 11 1 J 1Ml r nil
j( JU ~ICJ
HI 1101 IMlN
M 1l port o IvbnQcemcnt Hepurl-
nus annua L iepor t cons l at s of F0l111 SSA-4099 proposrl Io r 0 He Revr ced or Eliminated Rcport which is luruardec1 to OA
Deslroy after 2 years
VI SllPPLEfvfu1fIAL SECURITY llrCm-1F RECORDS
_A Slote St3iistics Reporls
lI
These monthly reports prepared at OR cont n i n data on payment s made by the llJClividual states
Re t ain permanently
the to
r0ques t of ISSI recipientsl
I I
I IIl_ I
VII
I
I
I I I 1
t I I I
B S3I PublLcot Luns i I I
Ihese reports ba sed on s t at i st i cs rece Lved monthlY ll01Jl DDT-and from the Bureau of Census arc pub Li slied
I
pe r i od icn l Ly JJj l he R SF ~3 Notes and as s pe c La L I I
i I I
i I I
I
I TJ~(~ rfC_lrd ~lC_CUllll11fllc in clrry1ng oui analyticol I
l1)(11c middot)f h- L~TCl )j rgtI[CrtllrlOnj- wuie tundl ng of PlO](Ii II ilIC~(Jlrl~ IJ1_rI1111l i on JIl the U Iho SLlKlicGI JJch ~I (ct 1dJ ~jilli~ LVr JlTect~ (gt1 Current Income-ihilli(IlI]l rILlilll~~ ()ll-f1lnl1r)1l E3iimCl1es and Fuir~lll ()lll IU j_lL~J lllo pulLi uhcd I n t he Soci~ll ~~eC11111 ) llnLhL ill tIl i11 tltr Im1L1al lot1stical I llJIJI~llI ~ I i lie Eullet Ln (ll her lone term pro jec t s jlICJIY ~Iliif [ 1Ilflre ]c[011n FtnulcillC ~f)cill
~tC1Tl l v -lld T j Vj I IcnjIJn PJnnG Dat) from the Durcn[ 1 lI~J IlIlIrnal lcV(li1IIC ervice and o l he r aL~(nci~ l~ llId in pr(~lJari1l~ 111(( ~jucllrmiddotG The Ton Lrgtl1il ~f lrJ1 il pnblisllell plLudjl~ol]y [mel may be rl)ml)LIl(d iutel a lllunJ[raph 01 c Lu II pape r
r0porLG
He I a Lu pe rmancnt ly-----ECONOlIITC fUm IDNC J0NrE ~ITLTl)IE~RECORDS
-_ _- - -- -- _ -- ------ -- - -- -------------- _-----__-__-------[OUI (opleJ illJudlng oiginal 10 be 8ubnuttod to th Nutionol ArclLivll ond RecoJd Service 16- ~U12~ 2 aPO
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
t~ NIItIIIIII 1)1111 II~J1)
1i I I J ~II 11 -t I It tl v I II r II 1 Pmiddotr 13 _ I) ~ 23 pllhll
HEQU1~~TI O~ iF JlHOldTY TO DlSPOSc Of nJ~COHDS-(untin1alion Sheet -------------~~-- ~~--- _- _ -- - ----------- --- --- ---- -~---~- _----- ~ - ~ -~--
Inn rill
I
II
)
111 r Oil IUU no rr liON TIIIW
10
I Re~(lld Copy (1 Iub Ljca t i ons
-
~~~ermanentlY
VIII
D Dackllround Data -I MEt_LFlbalB tndc(in-tO1ymiddot ~~ ~4lt~
~ c7~o A7~~z- ~eyenlaquoi--
ECONmrrC PROJECTIONS AND EARNINGS ANALYSIS
p~~~~ ~~~
RECORDS
i I
~~4 7 cl
I
I
~~- 17~~These records accumulate In projecting for budget pLanrrl ng purpos(s soc Ia L secur-t tv payroll tax revenue to the tru~i fund Inc Ludod but no t Llm ited to are 1
i I
A Prujcctions of OASDHI Tnx Liability and Collections I
1hL rrIYrl prepnred 8[ needed 101 nee by the o [flee of M~mogcment and Budget (Olvffi) llep9rtmenl of Treasury and oLher offices and bureaus pruJects the budeel pos i t i on of the soc ia L se cur-lt y revenue tax and Included mID and
the policy tmplLcat tons for l3 related backgr-ound data
o t ner offices
financing ve ce I ved from i
bull r ~
i DrtlOY after 10 years I
I
Ilu r anuua L rep01l wir h quar t erLy icvl aa ons
B P1OIrC IJ_ons for EcIa1)11llmentanrl ]Ilf-_llntenallce lur1loudc-
projer-1
of I
I I i s
frJr tJudgrl I)UlP)SCS the s e Le c t ed DDP wo rk Load s I
I two tLs ca I yen r s ln ad vance
1 Hecorll eL r
~ I I I
~~~l111mlCnllY bull I I
I I
lh J( I IJI _ 1 I )1 f r om BUF cmlto ln lcse_11ch rr~ga1din t iilplt)I1ll lId (~CnlLn( o f ]xrlll cove red by coc La L lllmiddotj 1] I i)0 llnplci -1 t he r c t I rement les t
7
n rd 1rl(VIlllt o l I 11( fjcllmiddot-(1l1lrJyecl bc twer-n wage and t1(1)Y Oir rk
___________ J]~l j~SJY_ illl~l- _Jl1_lli~r _Deecl~d_lr re ferenc~ GPQFoul ropir includlnq Guginal to be aubnuttcod to tho Notionol llrchiwe and Records SeaviC8
l
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
14
bull
NtIIIII 111 ) illl l I I Ii til J 1 I ~l bull ~ 1I I 1 I I rll I lnb No 1 I f ~ t bull I Ill f 23
RJOUrT rOR lUTHORITY 10 DISPOSr OF TIECOHD3---Continl1otion Shed __ -- h ~_ __ bull bullbull ~ bull __ __ __
I 10
Ill1 rlU ~fd1fmiddot1 r olaquo
101 I~O
D
Jh i t abn l a tLon record the t ot u Lo of oJd age l(Jremcnl ac+ Iouc bo+h by [11( a nd naLionally
fl ~~troy whe n no longer needed for re Ie rence
D LI-JBILTIY STUDIFS RECORDS
Jit(e rfc~()rds runsist of original and m l c ro It Lm Cypi- ef t abuLa t i ons of Bureau nf Ce ncuc que s t i on-IDlres pert~Lnlng to the socio-econmTIi~ status (cUt~h as r ncome assets health medical cos t c 11v i 11[ ar-rangement s and employment history) of applicant s fur d Lsubi Ll ty insurance The t abu La-t l onc are llGfd to prepare special reports on the r] i sa b Led c uch as IdlCnt Lfyinr th~ Dt sab Led r C(l11f~epd an-1 Methods in I-he Mrasnremrni of Disl3bllit lorl and Earnil1S Ul ih~ Disal10d Gnd O(On(-1a1 (J18racj-~rlSf Les
= r I ] I D 1 sol)ld bull Nbnolpoundraphs wh l ch Lnco rpo ra 1 lt broa1 S111ill1131iFs 0 111e-rr-por-t s are pub Ll s lied 01- t he (c)lllpl~-
1 Ln)1 _r tlv- s p--c l a L at ud i es bull
1 rQbulctt Ion
Destroy o rtg l na L docume nt s aft e r nu ca-of l Im I has been proven _accepLable IVDintain mi cr-ofLLm 1
~ Jnucfirn -_1 laquo a4~~ ~~ ~-u~-~ 7~-U~ti- pYadae ~~~J ~~~
rCIorl- r Juri llmIErtLphs ~04- ~ ~t~e4~ 7L-e~~J f ~=rtu lccorc1 C(IY rC1lTIClJl1l1-ly r -
r -
lllC~l rC((ll~ CUllJ ~ l(1n(~iLL1clir[l 2-]2 po r ceut jcllldulIl]r (-J~l-L JJl1llllt _I ltlLsrdJLIJ_ jn31u=cS
(_lllllill dt))(l[ll) ~-~]elIJn Irorn dLcnb l Lr iv in~LI-F )(11L_ Tll11ltllCllltGPlCVLll-d 1rcl]illl1f l I 11 U I l() 111_IJlICr ll1 JIl tape cont a i ns
~lil -hi -I~ 1 t( i~Cllll11 cllJrrllI1ISI iC3 )1 t-he
iJIlllr JII -1 prl 111111[1_ I) 11[f d i SClbJJ i t- Y pruIram )]1 I h llJlplr C I llec I-d 1- l t Ilf~ mc11 ca L Irrc l orc o tI
I d I JnbLli 1Y Luc l ud cd 11( Fo rmo C()-218~j OHa ---_------------------ -- -- --~- ------ -----------~ -~-----_-----__------- - ----
OUI (opies uu h~dlny anginal to be 5ubn1itted t lito Nutional Archives Ilfd Records Scolvice Ill-flU l2R 2 GPO
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
--IftIICII Jllll CI Ilii( I I l III (I 111
Ill 11I illll1 1 I It r d I I l 1 Illll 111 Jotl No p~l~rf _~ _l5 __ I I J 111~1 [ 23 _puc~
RlQU1~r FOR JUlHOHIry TO DIBPOSr Of RECORDS--(o11inualion Sheet ------------__--_-__--------------------_----__--
q1 III I~IIr()rOI Jlr~l 1G
~IM[gtU 11111 M fj) IH li1 I d rl 111Hl rJ I~I ILNli)rI P~IIHn)1 lln4 fAKi N 1)11 ilr)
CllmuclellLics o I ClainonL C(J-2185A-G Siatp Arrenc- IIniilo1Deie11ninaiLlnn and their equivalents Reportmiddots
wh l c h are prepared from the data r nc Lude I
I1 Pcri odic Dat~l Smrmnry i i
Published monthly or quarierly this report I cont a Lns the sampLe ui ze select ed characiLerist Ics oI the sample such as 380 sex medical lmpJlr-1 merrt t-YI)e of OCCUpCli ion and decision out come
2 Ploject ShClles
Pub l I s hed annua Lly the se r-epor-t s p~rtain to t h= I
I me t hodo lrgy of the d l sab lLf I-y progr-am such as I JJl1lll ud i na L Approach uf Reconsideration
De c Ls Proce ac and Evn Lua+LOll 1vledical i011 Prncess in 13DJ
lh~sC n)xlrts pleparcc1 perloltlLc~llly o+ t he rl1t-~1 her and c= s 01 laquot bUl~31)S uffj curta iJI clll Ft ()J1 ulljec1s such 33 Ul~ i-rllTJFtCi l1P01J r he puol ( llf propo(~l inc i-ea s ed Ul (leCr~~lrcl i COrECj~ll the cf1C~ct laquor a ))rcJJx1sfrl increased i care Lord ~llr] UI- clfeci S li[ 1 c harrred QClI1HLJpn
o t c1 L~ltl11Llt I s I
i I ~I bull
I~
1I copy permanent Ly bull (Jl~ro I pY
~iP r ~o
fl F-rm
cl bull lin I-c G
MgtiLnn JIl) fiB ]~-ltJ a~r ~-+~ U~-cc2~-e~~laquo~d~ aamp~e-~--6----
~Y ~-e-lt 7 ~~ r7-laquoltetACbull
- ---- -------------
-I
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
16
I 10
I r
itUJHlllftl ICI III 11011 1middot
I ~I 111 ) I rill I H l I I
Job r-fn _(1~1I~~ltI~~~d~f ~ 11Uh11
IHQUEST FOR AUTHORITY TO DISPOSE OF RJCOnDS--Conlinuution Sh()~l
ITrM NO
yH
-------_ _----------- H iJ ( 1~IPII~Ji4 or 111_1
iVI1t1 IrLlJ 11 UAII lIlt l[rIN11~HI rITllHImiddot)
C Procrmn Inalysis Reeords
These records consist of tabulat ions t ab Le s r-cpo r-t s and nlatec1 cor-re spondence regarding a ua Ly se s of the disability program and disability bc ne Ij cLar tea The reports are pub Ll s hed in the R f S Notes on such subjects as Adults Disabled Since Childhood Identifying Disabled Workers Ihe M3yReturn to Worlc Hehabilitaticm and middottodLcal Improvemenl Screning Decisions and 3p1111 ch Sm-name iJocJJl --Cllrj fy Beneficlar1cs Ln tile 30utbwesL The reports may be republished in t he iocial 3tcurjly Bl1ll~tin
i l rabulations I I
Des l-ruy aft er pubLacat ion of report s bull I
~ 2 ReportsI I
~~~ecord copy permanently I I I I
These documentc nccunmIat e in t he co l Lec t Lou of dat a for use Ln a tud Le s ef the tgec1 popuIat Lon and survivors of dr~ceor~dvor-ker s The da l a is received from the Bureau or Ccnu Lll lhe forms of or igLno L and nu cro rilm ccpi es of t ab ula t Loua and t apes Arter study the dat a l published in the J)ciol-ecurlfy Bullet1n on nuch s ubje c t c a c The Family Structure in Preretire-Jrlfll t eer LlS nllr[ ~) t BEll(JJ C Hl rie c bull The art lc Lo st uc1r-lLIre ie pri nt ect pEr-Ludlcally as suivey reporls Also incl uderl js ]elol~dcorrespondence
I Ij bull I I
I G T billet jrlilS rlml Tap I
110 t 01 n nJ dl L1 -~ ci1j~f ~~
J ImiddotAlMU (Ill I lOTI I AKlNJUli NO
~ -
~ t) L
111 -r-
jlf -(
~p-z ~~--egt~a~~c pa~ ~~~ ~eAay ~d-lt~ 7t ~~--lt--- ~~ I
_ --- -- -- --- -------Four tople lnchu)ng ouyillol to be subrnilted to the NohouoJ Archiv02 and Reco d $crvlCe
I
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
bull
NtllUdUll Iulll rO Iidu bull Hll rI L 1111 I I r II til l 1 III It ILl ~III I 11r llrlll Ioh No I ~ I~ I JII
RIQUEST FOH JUIHClRIIY TO DI3POSE OF lECORDS-Continuation Sheet
IT[M rIO (Wll II
o ILmiddotllIIII(N or I rJll ~ lt1JI uri I r n~nil
u r M
n~ 1I(gtrI Pr iI()P)
I SIIMPU Oil
iou NO
10 ss nON 1AI[ N
XI OASDI ~rJlISTIC~i IIECORDS
Iv PJrnlngGand tJllploYlIlent StatIst lcs 1I0cords
1 Ie t t erG to the Depnrlment of Treasury
1
I
I I I
J1
I 2
These annual reports Tax Refund Estimates and SIngle Employer Excess Taxes relate to the transfer of payments from the social cecur-Lt y trust fund to general revenue funds
EarJllngs and Employment Statistics Reports
~ i
Thene lcport s whlch are based on or-Lg l na L and microf~lm coples of statistical tabu-lations from OASDI program statlstics i llclude Inrt are not limited to the fo LLow-~l1C
a Ellllj DrS Distributions in the U8
IIu s report prepared annually provides data by standard metropolitan area on -Tcr1-ersand ear-nLngs in covered employment by age racE and sex
b i~ocial SecurHy Farm Statistics
This re por-t puhli 11edperiodically coni a Lnc 111a ()n the number of farm -l()rl~ru Iartn employers and self-employed fal1ncr~ by Stale
c ~inte QEd Lncal 3LCl j i3l irs
G()vclllmcnt lmploymenl
I I I
Ihi n repJrl J)111-) 1i shed annua Ll y COl t a ins data on l he numbcr )1 70rktls covered under s oc LaL secur i t v compared I () a l l 3tat~ courrt y and Lor-u l GUfPrllmelli employees
__ 1 _ ----------_ _- -------I --- __-
rOUl copf en ueluding nrigiuaJ to be ~ubmitled to tho Nntional ArchivE and Record Sorvice 1I-lU 28- 2 GPO
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
~ Hf)IIIIJlllt It rl) it)1 rl)t H 1 I ~ Ill r 1)-gt1 I I r 1 II I I It II ~I I I It I oh No I
JI I IIImiddot
HCOULSc rOR lUTHORITY TO DISPOSE OF HrCORD~--Co1linuati()n Sheet ------__-----_-_ -------_ _--
OH------------)-~1R I L (lnP II(H rlaquo IT M 1ll
111I rJ( tJJJL 1)1 r bull Ill III II [I(HI jtlIU liON rllrrl1)[( rio-_- ---__ imiddot -
cI (ounly 13uJiness P~lttelJlG I
Ih I s report JulJ1 l clred joint ly by S3A and the Bur-eau 01 Census J cont a Lns da ta on wor-ker-s and pnyrolls by cuunty and lndustry ful the IllgtivaL~ nonfarm cec t or of Lndus tr-v
e Other Periodic Reports
Ihe ce r(ports pub Li s hed In the Social ~ecmgtity Dl111rlLnand Ln the R amp 3 ~Joies Include such cubjec t s a Huuseho1d Emp10YlIle11 t Ullder OJSDHI Se 11- EllI1Joyed [TulLel Dt)cLols and ~~)cial ~ecur1iy Numbl Escuances
( 1) Ia bub ILOllS
Deo t roy after microfilm ve r LfLed as acc ura t e
bas b-olCn
jfI
I 1
[1- (l-~LJJllU] 11~11lll111 r - in prOpnllllg for Jul)lll~t Illl 11 t 1 (~~ m nf~DI YllIIil~ awl l iI(ItI T( plil] Icnt i onc include the q]Ill ~_Jjlii ltl~ I~ wliic h conln Lns Jlmlijlmiddott11 rJ 1 -1[1 1)(11 1 clllllcleLl and in
lliJlflll FlI )11 (i 11 11 -~lll~nUUland ILccn L (11 ~Ij p LII ud 1() juch 0 llIdmiddotnl
1311J1 11 11t II hrl cll lh~ II ~~ Ni-(s iI LI I) 1~1Jl~L1wd ill tllf monthly cmiddotL1 ~i 1IlIL liIJl1ci Jl r~d I the nnuul 1 c ILl 1[11-I lili1i IHI~l)J 11 IY rl)lj ~ant ~middotI Ii II I~ jul Lif]hr Ilmll und 111C)JSDI 11(1 I Imi [middott1 1~ 1) pub l ruhe-d annual Lv
) )
l)11 i fIll IlltWIll CUJIt bCllCfLl dn l a by h)I lj~iI lIilk)I~ Included a ie sp0cifl-
Four r OP1U$ I lie JUdinu onglnal 0 h~ JJuhuuUc-d to tho Nulional A~ChJvelll flnd nprorrls Service
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
NfalHtlid orr ~n JIf~l 1 I I I I -~I) I II I ~1 r I I Ir ll~
I T1 1 11 Inl HI ~I jb
I I~ bull t I _1111 Jub Nu
HpoundQlJEST ron JUTHOHITY TO DISPOSE OF HECOHDS--Continuutioll Sheet --__-_ _---------__---------__------__--------_ --
I I1LIIIIIIUN or II U I 10 ~M1I LF () n
ITI 11 no I jllt) jldr U 11-11N11()N Plrj(II~) I N 11011 111(01 JUB 110
- I_
I(~rlL-lJn tu1 UK _~l_ultlj(sI)ricinal and mlcro I l Lm I
CU1)l3 oI I abula t IOn and r-eLated correspondence I
1 labll_lalj)n
Dcct r oy D tr er rulcro tLlm has been proven ClC ceptab Le bull
2 Microlibn I __~~ ~4u~~ -e~~~ e-e~
lhlnLalli ~fplusmnnllZlT O~~P~~~ P~4~ ~~ ~y ~~~ 7~
Publj(al-iom ~j9k--- ~~ - I
J~ loa
~a It CIiI pound~u~COlCl cupy pe rmanen t Lv I I I
Dostroy afLcr 2 years
c Stat LSi Lcal ()p~raLlonG Records
1 R~i_lnlJursalle 3ervices Record
Ihe oe r]uclunents ac cumula t e in pr-oc eas i ng r-equc s t o fur at a l Lu t Lca L servlccs Iiom non-~-A)fllccs Inclucleci ore Forms i3A-1033 Ec t Imn t Lon Form flll Use in Hegoi-Lal_ing Rc Lmbiu-aab Le Services SA-IO~4Aljreement Cove r i ng le Irnbur-cub Le Services or equt vaLerrt fC)1111S and related cor-reupoudence
Dc~-luy a tte r 10 yeai-c
lherio recerlis C-i]IG i 1 -If cl)ll~sr-mcl(n(~r~from (f_llcr CrfLVo milch l1( lrvllLLtrn as spcltdi-11 l onr 1)1 JiltL~111_nl ilalD t o b(~ PlI)c(oGsed
1)1 BliP Jill sprC~JJLC~lti(ll1~d euc rLbe tlie P11U1J111~l~ o ill~ JtI11iy 10 bo unJelial(ll
I
I I
I I I I I
_________ - - _1 __ - _ i - - - --------- - --- --- - -- ----- - - ---- --- -- ---- ----- ------ -- - - -- ---- --- --- -----
il)ur (OpICII IOC hrlu OrlUlllnJ to be IIubttlillcd to til Nutlonal At(hiU~ and Rocords SCkvce
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
AtnlHJnrtl FOlln No I~re t
IPII 1IIIIlII lq~11( ( I 11H-l 11 r I 1(Id--1 rv ~ tllrIJII~tlntlol Job No _ UH IV~ r 1 10
REQUESr FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet
97 8 [)lA~nIPTION OF ITrM 10 SAMPLE OR ITEM NO WlfIl INCLUSIVEDAH5 OJ HI rUCTION PERIODS) ACTION TAKENJOB NO
------- - - --------- --- --------- -- - - ------- --_ ----- ---- ------------------
D Stat ist ical Systems Coordinot ion Records
1 Special Projects
Ihe se records consist of d ocumerrt s pertaining to projects under+aken at the request of other offices and bureaus Included are copIes of destgn speciflcattons punchcards and tabulations for the pr)jects such as the Longitudinal Dt aabrLlty Appll carrt s ~3Dmple and Bene j i ciar-ies Earrnngs and Retirement Data
Destroy after 3 years
E MannfementStatistics and Servtces Records
1 ~ervices Records
These r-ecoi-d s cons Lst of doc ument s such as ques t Lonna l re s object Lve s and specifica-t 1ons acc umuLat ed in analyzing data which J G published lJY ot her bureaus and offices
Destroy Jfter publLcat Lon of data
Foul tOPI(gtS including origlnal to be lIubnlllied to the Notional A-chives and Recoldu Service
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
----------------7
I I L
I
fllll~HHI 101 f ~I I Lil H I I II ILl)1 llt
I I I II I I (i I 1 ~ II J ( l uraquo
I
s I
II ~l L I I Jllb Nt)
I~EQ(JrSl rOR AUTHORIlY TO DISPOSE OF RECORDS-CunEnuution Sheet
1gt1 Ul11 1(11or Ilrr1 Ii)(fMPL OJ
(Nil II JIlL ilfl) I)l~ HCIUIIuN PI no) ArlCgtl~ ItK[NCM 110 IH Il 1_-
These ncumellts ucll as random curnpl Lng uf bureau oc1 ivities are ac cumuIa l ed Ln e s t imat Lng lrUllload and e t affLng requjre-ment s necessary to carry out 3~A ac t l vi t Le a Ln the bureaus and offices Tables of ant Lc i pa lell wo rkLoad prepared quar+ cr-Ly semt annnn Lly and annually are forwarded 10 the requesting o tILce The taped quarterly tab Le 1 ujxIa ted every 21 mont hs
Q Giunrrly ond ~ellliamlllal 1a1l1e8
Destroy after 1 yenr
b Annua L Toble
Destroy after receipt of next Quarterly 1able
XII HEALTH UJSUHJHCE EECOrrDS
Ihe files descrlbed be Lov accumuLnt e ill 1- he de ve Lop-ment of n s t a t Ls Ljca L program whi ch provides infor-mar Lori recnru Lng Medicare for -~=A offices and bureaus and for the heu Lt h community at large
A Program Statisllcs rrabulatiolls
Ihe s e records cons l s t of tabula t l oris prepared botl1 from appllca11ons Crom benef-Lc1aries and pro j uere of healt 11 care and Irom cu r-r -iF l payment recuJl~ lECelV~d in BIrr on carrier ut Ll Lza t ron
Iranc r~r t o t lie SDA Relords Hold tllC Area when lJu l)T1I(~r ne~ued Jn currenC opera rouc Desf roy wlie n 110 lUlWCI neFcird ror reJr~r(llce
il 1S(middot Jecc)rltl~ ClllJ I 3L o I mon l h Ly and qua r t er-Ly VllrLlund rel)i l_IV(~rl Irom ullUvidual Lnl-er-ll(rlL~LLH~S nnd cu rr Lcrts bull Iho work Load reports u nd
tnfurrn8i Lou lr_lll I he b iLl a for Gelvices cubnrl tr ed by lll2 In-crmeu-Ll1l(~~ and carr1ere are pub Li uhed
___ ~H _ __ _ _ _ _ _ _ ---_- - --------_---- - - 0 ------ ------
FOLlI (OpICIil int lurJiuy (Il1glUru to be subuulted 10 the Nohollvl ilrchive and Recolds Sea-vice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
bull I
J
Stululunl Ior 111~C) llnh I 1 d 111 h I Ij 111 I I oj I T JlId - I II ~
(11 H ~ 1 1111 -nu rJHIIIlH Job No Pn~e_~_
of _23_ pngel
REQUEST rOR AUTHORIrY TO DISPOSE OF RECORDS-Continuation Sheet
9I a IfltfIP liON or ITLM 10~AMPI E Oft 11[M NO IWIIIi ItICUt-lVl [A 11- un flIIIJolJ~)PI PLRIOOS) ACTION TAKNJOB NO
---------- ---- ------ ---- -- -----------------
JIlnl1lhly and qua r t e r Ly -i 11 a comb l ned Index The info rma t lon in i he Index Ls taped the tape 18
ma i n tn i ned e Lsnwhe re bull
1 iul]l()9cl Report s
D~s t roy after tapinc of the Index
2 IlKlox
r~t 1~ f
~~i~ecord copy permanently - -
c HealLh Insur8nc Reports
1 ClVlS RCpolt s
Tho r nfot-ma t f ou l n the CMS is the basis for monthly rnd quarterly reports such a s Heal h IncurUlcc Intermediarv Worl~loQQG 3lVlI CuTi ~l [w]] IQdReport and fHE
C~rrlcr Appenls Activity
______ _ _ L _
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice
SfulldHlf1 nr III No Illia ftrmiddotllt Nn1 rnlraquo r lor J
11(01 111 liv f 11111 r d ~ I I( I r 1111 r IllIIII No ~---_ --- Pn~( __23 __ (1-- tl ~ 1 11111 I I J bull
or _ 23_11Ifs
HluurST FOR AUTHOHItY TO DISPOSE OF RECOHDS-ContinuCliOll Sheet --------------_ __ _-------------------__--_ __ ___------
I 8 url HII IICHI(11 III M f) 10
~A~HLr Oil 11[M NO (Willi I~Kur(VL [JAil nH PUINlllIN prnl)Ij ~rrION TAKIoNJOB I~()
1 _
This seriFs composed (Jf seven sec IIons relates to a pa rt Lculrrr pha se of health +nsur-ance such as part Lc Lpat t ng houpr t a Ls enrullment and all overall curnnary
3 Reimbursement by State and Countz
lhis 3111lUnlreport contains statistics on Iledicare Hea lt h Insurance for the Aged Amount S Rc imbuiced by State and County
I (lther III Eeporls
These annua L or one-time reports lelQting to the JvJedlcale progrCllll un such subJects ClS CIvr3 DaLa and Preccliption Drugs are published 1n the R amp~ S IkteG 311d ill the eMD Notes
Record 3e1 0 r leportc
JI ~~fi~)(rmanent ly
D SpcLficaiiJn I1=questG
Iheae recordc conc i c t of correspundCllC( w i t h J3Dr out Li ning t lie speCLfictfLuns 10 be uocd in compiling da t a requesled for 11i(iLes such as whi ch data
I I fl1ec to use how to t abuln t e the data and what ( to I nc Lude and tu exc Lud e
i _ __ --1 _
Four (OlUltiS iurhuliug I)riUlnal lu lie tmbnl1t1cd 10 the Notional Ax(hn and R(cnrd SQlvice