Immunization Information Systems (IIS) were created to improve the quality of immunization record keeping. IIS is a powerful tool with the potential to transform the management of immunization record keeping is managed. Participation in IIS is voluntary, with few incentives for healthcare providers or parents to maintain the records. Most of the research to date has been focused on vaccine compliance. Little examination has focused on IIS penalties and procedures. This research examines the role of penalties and the penalty enforcement process for immunization records for children ages 0–6. The purpose of this study was fivefold: (a) to describe how have states enforced penalties in IIS related laws and statues (b) to describe what program-level penalties have immunization programs developed for violation of IIS program policies and processes (c) to describe how program level penalties are enforced (d) to describe how IPMs perceive legal and program level IIS penalties (e) to describe changes IPMs recommend related to IIS penalties. Key findings include: unclear enforcement of existing penalties; few recommendations to change existing policies or penalties to increase compliance; no one group is responsible for enforcing penalties; and only incentive to increase IIS reporting is free vaccine, but this is not substantial to improve vaccination record keeping.