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 theMDH 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. Each Agency or Program should have a Records Coordinator. If you are unsure who your Coordinator is, inquire with your Program Director or email mdh.recordsoffice@maryland.gov.
Enter the Description of Records. Enter the description as it is listed on the records schedule and include additional identifiers as needed. Spell out acronyms and do not enter any PHI or PII. Each record set must have a description.
Enter the Format of the Records. Record formats include, but are not limited to, paper, CD, film, microfilm, X-ray, thumb drive, and VHS. Each record set must have a format. (Contact the Records Office for guidance on disposing of records in formats other than paper.)
Enter your Program’s Records Retention Schedule Number. Click here to locate your program’s records retention schedule. You must use the schedule for your Agency/Program. If your Agency/Program does not have a dedicated schedule, use schedule 2913. Each record set must have a schedule number.
Enter the Item Number. The Item Number is found on your records schedule and is the number associated with the record type. If you are unsure of which Item Number to use, contact your Records Coordinator or the MDH Records Office. Each record set must have an item number.
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 the records 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. Each record set must have an inclusive date range.
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. Each record 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 and scroll to the bottom of the form. If your MDH Program is located on West Preston Street and you need assistance with disposing of 10 or more records boxes, select the corresponding checkbox.
Select “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. Paper 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. (Remember to contact the Records Office for disposal guidance if the records are in a format other than paper.)

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