Certificate of Records Disposal Requests

A Certificate of Records Disposal Request is a request to destroy records that an Agency no longer needs. Records must be destroyed in accordance with the Agency’s approved Records Inventory and Retention Schedule.

MDH records disposal requests must be submitted via the MDH Certificate of Records Disposal Form.

Annotated Code of Maryland State Government Article 10, Section 616 states that when records are destroyed in accordance with an approved schedule, the Agency must submit a certificate of records disposition (also known as a disposal certificate) to the Maryland State Archives. The MDH Records Office submits the Disposal Certificate to the Maryland State Archives.

How to Complete the Certificate of Records Disposal Request Form

Open the Certificate of Records Disposal Request Form.
Select your Secretariat from the drop-down menu. This is a required field. Review the MDH Organization Chart to determine the appropriate choice.
Complete the following required fields:

MDH Agency/Division (Example: PHPA/Environmental Health Bureau)
Location (Your office address)
First Name (Your first name)
Last Name (Your last name)
Title (Your work title)
Phone (Your work phone)
Email (Your work email)

Enter your Records Coordinator’s email address (required). Each Agency has a Records Coordinator. If you are unsure of who your Coordinator is, email mdh.recordsoffice@maryland.gov. When the disposal request is approved or denied, or if there are any questions, we will email you and the Coordinator.
Enter the Description of Records. Please group all similar description items on one line. When typing the description be as descriptive as possible, spell out all acronyms and do not enter any PHI or PII. Only the first Description of Records is required, but if you have multiple record sets each set must have a description.
Enter the Format of the Records. Normally this would be paper, but you also could have a box with film, a box with computer disks, etc. Only the first Format of Records is required, but if you have multiple record sets each set must have the format listed.
Enter the appropriate MDH Records Retention Schedule Number. Click here to locate your Agency’s Records Retention Schedule. In most instances, you must use the schedule that is specific to your Agency. Not all units have a schedule; however, all MDH Headquarters Units, Local Health Departments and Facilities can use Schedule 2913. If you are unsure of which schedule to use, contact your Records Coordinator. Only the first Schedule Number is required, but if you have multiple record sets each set must have the Schedule Number listed.
Enter the Item Number from your record schedule that matches your description of records. If unsure of what Item Number to use, contact your Records Coordinator. Only the first Item Number is required, but if you have multiple record sets each must have the Item Number filled in.
Enter the Inclusive Dates of Records. This is the earliest date of the record set through the last date in the record set (Ex: 1-1-2020 - 10-16-2020). The records in the boxes must fall within the identified date range. The latest date will be used to determine if therecords have reached maturity and are ready for disposal. Only the first Date of Records is required, but if you have multiple record sets each set must have the Inclusive Dates listed.
Enter the Volume (Number of Boxes). This must be a whole number. A partially filled box is considered one box. Only the first Volume is required, but if you have multiple record sets each set must have the Volume listed.
Repeat steps 5 through 10 for each record set. You can enter up to 16 record sets.
Review your entries for accuracy, scroll to the bottom, click “Send me a copy of my responses” and enter your email address.
Click Submit.
Await a response from an MDH Records Office team member. Do not destroy any records until you have received approval.
If approved, dispose of the records. Records containing PHI, PII and other forms of confidential information should be shredded. After disposal, email the method and date of disposal to the MDH Records Office team member that approved your request.

Denied Requests
The Records Office will provide guidance on all denied requests.

Contact Us

Maryland Department of Health Records Management Program

201 W. Preston Street Baltimore, MD 21201

410-767-5314 office

410-333-7194 fax mdh.recordsoffice@maryland.gov

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Maryland Department of Health
Office of Internal Controls, Audit Compliance & Information Security

Certificate of Records Disposal Requests