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Fill a Valid CDC U.S. Standard Certificate of Live Birth Template

The CDC U.S. Standard Certificate of Live Birth form is an essential document used to officially record the birth of a child in the United States. This form not only serves as proof of identity but also plays a crucial role in various legal and administrative processes. To ensure accurate and timely registration, it is important to fill out this form correctly; click the button below to get started.

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Table of Contents

Form Overview

Fact Name	Description
Purpose	The CDC U.S. Standard Certificate of Live Birth form is used to officially document the birth of a child in the United States.
Standardization	This form is standardized across the U.S. to ensure consistency in the recording of birth information.
State Regulations	Each state may have specific regulations governing the use of this form, often outlined in state vital statistics laws.
Data Collection	The information collected on this form is used for public health statistics and to establish identity and citizenship.

Common Questions

What is the CDC U.S. Standard Certificate of Live Birth?
The CDC U.S. Standard Certificate of Live Birth is an official document used to record the birth of a child in the United States. It serves as proof of birth and includes essential information such as the child's name, date of birth, place of birth, and parent details.
Who is responsible for completing the form?
The hospital or birthing facility typically completes the form. However, parents may need to provide information about themselves and the child. It is important to ensure that all details are accurate and complete.
How do I obtain a copy of the birth certificate?
To obtain a copy of the birth certificate, you can contact the vital records office in the state where the birth occurred. Each state has its own process, which may include submitting a request form, providing identification, and paying a fee.
What information is required on the form?
The form requires various details, including:
- Child’s full name
- Date and time of birth
- Place of birth (hospital or facility name)
- Parent(s) names and information
- Birth weight and length
Can I make corrections to the birth certificate?
Yes, corrections can be made if there are errors. The process for making corrections varies by state. Generally, you will need to provide documentation to support the changes and may need to submit a correction form.
Is the birth certificate needed for any legal purposes?
Yes, the birth certificate is often required for various legal purposes. These may include applying for a Social Security number, enrolling in school, obtaining a passport, or proving citizenship.
How long does it take to receive the birth certificate?
The time it takes to receive a birth certificate can vary. Generally, it can take anywhere from a few days to several weeks, depending on the state’s processing times and whether you request it in person or by mail.
What if the birth occurred outside of a hospital?
If a birth occurs outside of a hospital, such as at home, the parents must still file the birth certificate. They may need to work with a midwife or other healthcare provider to complete the necessary documentation.
Are there any fees associated with obtaining a birth certificate?
Yes, most states charge a fee for obtaining a certified copy of the birth certificate. The fee varies by state and may depend on the number of copies requested.
Can I request a birth certificate online?
Many states offer online services for requesting a birth certificate. You can check your state’s vital records website for specific instructions and options for online requests.

Documents used along the form

The CDC U.S. Standard Certificate of Live Birth is a crucial document that serves as the official record of a person's birth in the United States. Alongside this certificate, several other forms and documents are commonly utilized for various purposes, such as legal identification, healthcare, and social services. Below is a list of related documents that often accompany the birth certificate.

Social Security Card: This card is issued by the Social Security Administration and provides a unique identification number. It is essential for employment, tax purposes, and accessing government benefits.
Birth Registration Form: This form is typically completed by the hospital or birthing facility. It captures necessary information to register the birth with the state and is often used to create the official birth certificate.
Certificate of Live Birth (State-Specific): Some states may have their own versions of the birth certificate. These documents can vary in format and may include additional information specific to state requirements.
Alabama Bill of Sale Form: To facilitate the transfer of personal property, explore the detailed Alabama bill of sale form guidelines for accurate documentation.
Parentage Acknowledgment Form: This form is used to establish legal parentage when parents are unmarried. It is important for legal rights concerning custody and child support.
Medical Records: These documents contain information about the birth, including prenatal care and any complications during delivery. They are important for ongoing healthcare management.
Passport Application: A passport application may require a birth certificate as proof of citizenship. This document is essential for international travel.
School Enrollment Forms: Many educational institutions require a birth certificate for enrollment. This document verifies the child's age and identity.

Understanding the various forms and documents associated with the CDC U.S. Standard Certificate of Live Birth is essential for navigating legal and administrative processes. Each document plays a significant role in establishing identity, legal rights, and access to services throughout an individual's life.

Preview - CDC U.S. Standard Certificate of Live Birth Form

U.S. STANDARD CERTIFICATE OF LIVE BIRTH

LOCAL FILE NO.							BIRTH NUMBER:
C H I L D	1. CHILD’S NAME (First, Middle, Last, Suffix)			2. TIME OF BIRTH	3. SEX			4. DATE OF BIRTH (Mo/Day/Yr)
C H I L D				(24 hr)
	5. FACILITY NAME (If not institution, give street and number)	6. CITY, TOWN, OR LOCATION OF BIRTH				7. COUNTY OF BIRTH
			8b. DATE OF BIRTH (Mo/Day/Yr)
M O T H E R	8a. MOTHER’S CURRENT LEGAL NAME (First, Middle, Last, Suffix)		8b. DATE OF BIRTH (Mo/Day/Yr)

8c. MOTHER’S NAME PRIOR TO FIRST MARRIAGE (First, Middle, Last, Suffix)

8d. BIRTHPLACE (State, Territory, or Foreign Country)

9a. RESIDENCE OF MOTHER-STATE

9b. COUNTY

9c. CITY, TOWN, OR LOCATION

9d. STREET AND NUMBER

9e. APT.

NO.

9f. ZIP CODE

9g. INSIDE CITY

LIMITS?

□ Yes □ No

F A T H E R

10a. FATHER’S CURRENT LEGAL NAME (First, Middle, Last, Suffix)

10b. DATE OF BIRTH (Mo/Day/Yr)

10c. BIRTHPLACE (State, Territory, or Foreign Country)

CERTIFIER

11. CERTIFIER’S NAME: _______________________________________________

12. DATE CERTIFIED

13. DATE FILED BY REGISTRAR

TITLE: □ MD □ DO □ HOSPITAL ADMIN. □ CNM/CM □ OTHER MIDWIFE

______/ ______ / __________

□ OTHER (Specify)_____________________________

YYYY

MM DD

YYYY

INFORMATION FOR ADMINISTRATIVE

USE

M O T H E R

14. MOTHER’S MAILING ADDRESS:

9 Same as residence, or: State:

City, Town, or Location:

Street & Number:

Apartment No.:

Zip Code:

15. MOTHER MARRIED? (At birth, conception, or any time between)

□ Yes

□ No

16. SOCIAL SECURITY NUMBER REQUESTED

17. FACILITY ID. (NPI)

IF NO, HAS PATERNITY ACKNOWLEDGEMENT BEEN SIGNED IN THE HOSPITAL? □ Yes

□ No

FOR CHILD?

□ Yes

□ No

18. MOTHER’S SOCIAL SECURITY NUMBER:

19. FATHER’S SOCIAL SECURITY NUMBER:

INFORMATION FOR MEDICAL AND HEALTH PURPOSES ONLY

M O T H E R

F A T H E R

Mother’s Name ________________

Mother’s Medical Record No. _________________________

20. MOTHER’S EDUCATION (Check the		21. MOTHER OF HISPANIC ORIGIN? (Check
	box that best describes the highest		the box that best describes whether the
	degree or level of school completed at		mother is Spanish/Hispanic/Latina. Check the
	the time of delivery)		“No” box if mother is not Spanish/Hispanic/Latina)
□	8th grade or less	□	No, not Spanish/Hispanic/Latina
□	8th grade or less	□ Yes, Mexican, Mexican American, Chicana
□	9th - 12th grade, no diploma	□ Yes, Mexican, Mexican American, Chicana
□	9th - 12th grade, no diploma	□	Yes, Puerto Rican
□	High school graduate or GED	□	Yes, Puerto Rican
□	High school graduate or GED	□
	completed	□	Yes, Cuban
□	Some college credit but no degree	□	Yes, other Spanish/Hispanic/Latina
□ Associate degree (e.g., AA, AS)			(Specify)_____________________________
			(Specify)_____________________________

□Bachelor’s degree (e.g., BA, AB, BS)

□Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)

□Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)

23. FATHER’S EDUCATION (Check the		24. FATHER OF HISPANIC ORIGIN? (Check
	box that best describes the highest		the box that best describes whether the
	degree or level of school completed at		father is Spanish/Hispanic/Latino. Check the
	the time of delivery)		“No” box if father is not Spanish/Hispanic/Latino)
□	8th grade or less	□	No, not Spanish/Hispanic/Latino
□	8th grade or less	□ Yes, Mexican, Mexican American, Chicano
□	9th - 12th grade, no diploma	□ Yes, Mexican, Mexican American, Chicano
□	9th - 12th grade, no diploma	□	Yes, Puerto Rican
□	High school graduate or GED	□	Yes, Puerto Rican
□	High school graduate or GED	□
	completed	□	Yes, Cuban
□	Some college credit but no degree	□	Yes, other Spanish/Hispanic/Latino
□ Associate degree (e.g., AA, AS)			(Specify)_____________________________
			(Specify)_____________________________

□Bachelor’s degree (e.g., BA, AB, BS)

□Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)

□Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)

22.MOTHER’S RACE (Check one or more races to indicate what the mother considers herself to be)

□White

□Black or African American

□American Indian or Alaska Native

(Name of the enrolled or principal tribe)________________

□Asian Indian

□Chinese

□Filipino

□Japanese

□Korean

□Vietnamese

□Other Asian (Specify)______________________________

□Native Hawaiian

□Guamanian or Chamorro

□Samoan

□Other Pacific Islander (Specify)______________________

□Other (Specify)___________________________________

25.FATHER’S RACE (Check one or more races to indicate what the father considers himself to be)

□White

□Black or African American

□American Indian or Alaska Native

(Name of the enrolled or principal tribe)________________

□Asian Indian

□Chinese

□Filipino

□Japanese

□Korean

□Vietnamese

□Other Asian (Specify)______________________________

□Native Hawaiian

□Guamanian or Chamorro

□Samoan

□Other Pacific Islander (Specify)______________________

□Other (Specify)___________________________________

26. PLACE WHERE BIRTH OCCURRED (Check one)	27. ATTENDANT’S NAME, TITLE, AND NPI	28. MOTHER TRANSFERRED FOR MATERNAL
□ Hospital	NAME: _______________________ NPI:_______	MEDICAL OR FETAL INDICATIONS FOR
□ Freestanding birthing center	NAME: _______________________ NPI:_______	DELIVERY? □ Yes □ No
□ Freestanding birthing center		IF YES, ENTER NAME OF FACILITY MOTHER
□ Home Birth: Planned to deliver at home? 9 Yes 9 No	TITLE: □ MD □ DO □ CNM/CM □ OTHER MIDWIFE	IF YES, ENTER NAME OF FACILITY MOTHER
□ Home Birth: Planned to deliver at home? 9 Yes 9 No	TITLE: □ MD □ DO □ CNM/CM □ OTHER MIDWIFE	TRANSFERRED FROM:
□ Clinic/Doctor’s office	□ OTHER (Specify)___________________	_______________________________________
□ Other (Specify)_______________________	□ OTHER (Specify)___________________
□ Other (Specify)_______________________

REV. 11/2003

MOTHER

29a. DATE OF FIRST PRENATAL CARE VISIT

29b. DATE OF LAST PRENATAL CARE VISIT

30. TOTAL NUMBER OF PRENATAL VISITS FOR THIS PREGNANCY

______ /________/ __________ □ No Prenatal Care

______ /________/ __________

M M

D D

YYYY

M M

D D

YYYY

_________________________ (If none, enter A0".)

31. MOTHER’S HEIGHT

32. MOTHER’S

PREPREGNANCY WEIGHT

33. MOTHER’S WEIGHT

AT DELIVERY

34. DID MOTHER GET WIC FOOD FOR HERSELF

_______ (feet/inches)

_________ (pounds)

DURING THIS PREGNANCY? □ Yes □ No

35. NUMBER OF PREVIOUS

36. NUMBER OF OTHER

37. CIGARETTE SMOKING BEFORE AND DURING PREGNANCY

38. PRINCIPAL SOURCE OF

LIVE BIRTHS (Do not include

PREGNANCY OUTCOMES

For each time period, enter either the number of cigarettes or the

PAYMENT FOR THIS

this child)

(spontaneous or induced

number of packs of cigarettes smoked. IF NONE, ENTER A0".

DELIVERY

losses or ectopic pregnancies)

Average number of cigarettes or packs of cigarettes smoked per day.

□ Private Insurance

35a.

Now Living

35b. Now Dead

36a. Other Outcomes

Number _____

# of cigarettes

# of packs

□ Medicaid

Three Months Before Pregnancy

_________

________

□ Self-pay

First Three Months of Pregnancy

_________

________

□ Other

□ None

Second Three Months of Pregnancy _________

________

(Specify) _______________

Third Trimester of Pregnancy

_________

________

35c. DATE OF LAST LIVE BIRTH

36b. DATE OF LAST OTHER

39. DATE LAST NORMAL MENSES BEGAN

40. MOTHER’S MEDICAL RECORD NUMBER

_______/________

PREGNANCY OUTCOME

______ /________/ __________

Y Y Y Y

_______/________

M M

D D

YYYY

Y Y Y Y

MEDICAL

41. RISK FACTORS IN THIS PREGNANCY

43. OBSTETRIC PROCEDURES (Check all that apply)

46. METHOD OF DELIVERY

(Check all that apply)

AND

Diabetes

□ Cervical cerclage

A. Was delivery with forceps attempted but

HEALTH

□

Prepregnancy

(Diagnosis prior to this pregnancy)

□ Tocolysis

unsuccessful?

□

Gestational

(Diagnosis in this pregnancy)

External cephalic version:

□ Yes

□ No

INFORMATION

B. Was delivery with vacuum extraction attempted

Hypertension

□ Successful

□

Prepregnancy

(Chronic)

□ Failed

but unsuccessful?

□

Gestational

(PIH, preeclampsia)

□ None of the above

□ Yes

□ No

□

Eclampsia

C. Fetal presentation at birth

□ Previous preterm birth

□

Cephalic

44. ONSET OF LABOR (Check all that apply)

□

Breech

□ Other previous poor pregnancy outcome (Includes

□ Premature Rupture of the Membranes (prolonged, ∃12 hrs.)

□

Other

perinatal death, small-for-gestational age/intrauterine

D. Final route and method of delivery (Check one)

growth restricted birth)

□ Precipitous Labor (<3 hrs.)

□ Vaginal/Spontaneous

□ Pregnancy resulted from infertility treatment-If yes,

□ Prolonged Labor (∃ 20 hrs.)

□ Vaginal/Forceps

check all that apply:

□ Vaginal/Vacuum

□ Fertility-enhancing drugs, Artificial insemination or

□ None of the above

□ Cesarean

Intrauterine insemination

If cesarean, was a trial of labor attempted?

□ Assisted reproductive technology (e.g., in vitro

□ Yes

45. CHARACTERISTICS OF LABOR AND DELIVERY

fertilization (IVF), gamete intrafallopian

□ No

(Check all that

apply)

transfer

(GIFT))

□

Induction of labor

47. MATERNAL MORBIDITY (Check all that apply)

□ Mother had a previous cesarean delivery

(Complications associated with labor and

□

Augmentation of labor

If yes, how many __________

delivery)

□

Non-vertex presentation

□

Maternal transfusion

□ None of the above

□ Steroids (glucocorticoids) for fetal lung maturation

□ Third or fourth degree perineal laceration

42. INFECTIONS PRESENT AND/OR TREATED

received by the mother prior to delivery

□

Ruptured uterus

DURING THIS

PREGNANCY (Check all that apply)

□ Antibiotics received by the mother during labor

□

Unplanned hysterectomy

□ Clinical chorioamnionitis diagnosed during labor or

□ Admission to intensive care unit

□

Gonorrhea

maternal temperature >38°C (100.4°F)

□ Unplanned operating room procedure

□

Syphilis

□ Moderate/heavy meconium staining of the amniotic fluid

following delivery

□

Chlamydia

□ Fetal intolerance of labor such that one or more of the

□ None of the above

□

Hepatitis B

following actions was taken: in-utero resuscitative

□

Hepatitis C

measures, further fetal assessment, or operative delivery

□ Epidural or spinal anesthesia during labor

□ None of the above

NEWBORN

Mother’s Name ________________

Mother’s Medical Record No. ____________________

NEWBORN INFORMATION

48. NEWBORN MEDICAL RECORD NUMBER	54. ABNORMAL CONDITIONS OF THE NEWBORN				55. CONGENITAL ANOMALIES OF THE NEWBORN
			(Check all that apply)		□		(Check all that apply)
49. BIRTHWEIGHT (grams preferred, specify unit)	□	Assisted ventilation required immediately				Anencephaly
					□	Meningomyelocele/Spina bifida
______________________		following delivery			□	Cyanotic congenital heart disease
9 grams 9 lb/oz	□				□	Congenital diaphragmatic hernia
		Assisted ventilation required for more than
					□	Omphalocele
		six hours
50. OBSTETRIC ESTIMATE OF GESTATION:					□	Gastroschisis

_________________ (completed weeks)	□	NICU admission			□	Limb reduction defect (excluding congenital
						amputation and dwarfing syndromes)
	□	Newborn given surfactant replacement			□ Cleft Lip with or without Cleft Palate
					□	Cleft Palate alone
		therapy
51. APGAR SCORE:
					□	Down Syndrome
Score at 5 minutes:________________________
	□	Antibiotics received by the newborn for				□	Karyotype confirmed
If 5 minute score is less than 6,
Score at 10 minutes: _______________________		suspected neonatal sepsis			□	□	Karyotype pending
	□	Seizure or serious neurologic dysfunction				Suspected chromosomal disorder
						□	Karyotype confirmed
52. PLURALITY - Single, Twin, Triplet, etc.	□ Significant birth injury (skeletal fracture(s), peripheral				□	□	Karyotype pending
						Hypospadias
(Specify)________________________		nerve	injury, and/or soft tissue/solid organ hemorrhage
					□	None of the anomalies listed above
		which	requires intervention)
53. IF NOT SINGLE BIRTH - Born First, Second,
Third, etc. (Specify) ________________	9 None of the above


56. WAS INFANT TRANSFERRED WITHIN 24 HOURS OF DELIVERY? 9 Yes 9 No				57. IS INFANT LIVING AT TIME OF REPORT?				58. IS THE INFANT BEING
IF YES, NAME OF FACILITY INFANT TRANSFERRED				□ Yes □ No □ Infant transferred, status unknown				BREASTFED AT DISCHARGE?
TO:______________________________________________________								□ Yes □ No

Rev. 11/2003

NOTE: This recommended standard birth certificate is the result of an extensive evaluation process. Information on the process and resulting recommendations as well as plans for future

activities is available on the Internet at: http://www.cdc.gov/nchs/vital_certs_rev.htm.

Common mistakes

Filling out the CDC U.S. Standard Certificate of Live Birth form can be a straightforward process, but many people make common mistakes that can lead to delays or complications. One frequent error is not providing accurate information about the parents. This includes misspelling names or using incorrect birth dates. Such inaccuracies can create problems later when trying to obtain official documents or benefits.

Another mistake involves failing to include all required signatures. Both parents must sign the form, and if one parent is absent, the form may need additional documentation. Forgetting this step can result in the form being rejected, which can delay the issuance of the birth certificate.

Many people overlook the importance of selecting the correct method of delivery. Whether the birth was vaginal or cesarean should be clearly indicated. Misclassification can lead to issues in medical records and may affect future healthcare decisions.

Inaccurate information regarding the place of birth is another common error. The form requires the exact location, including the hospital name or the city and state. Providing vague or incomplete details can complicate the verification process and create unnecessary hurdles.

Finally, individuals often neglect to double-check the entire form before submission. Simple typographical errors or omissions can lead to significant delays. Taking a moment to review the completed form can save time and ensure that the birth certificate is processed smoothly.

Similar forms

The CDC U.S. Standard Certificate of Live Birth form is an important document for recording the birth of a child. Several other documents serve similar purposes in different contexts. Here’s a list of those documents:

Birth Registration: This is the official recording of a birth by a government authority. Like the Certificate of Live Birth, it includes details such as the child's name, date of birth, and parents' information.
Hospital Birth Record: This document is created by the hospital where the birth occurs. It includes medical information and is often used to create the official birth certificate.
Certificate of Live Birth (State Variations): Different states may have their own versions of the birth certificate. They contain similar information but may vary in format and design.
Adoption Certificate: This document is issued when a child is legally adopted. It serves a similar purpose by establishing the legal identity of the child and their new family.
Passport: A passport is a government-issued document that verifies identity and citizenship. It often requires a birth certificate for application, linking it to the birth record.
Social Security Card: This card is issued by the Social Security Administration and requires a birth certificate for application. It is essential for identity verification and benefits.
Medical Records: These records document a person's health history and include information from birth. They are important for ongoing medical care and can reference the birth details.
School Records: Schools often require proof of birth for enrollment. These records may reference the birth certificate to confirm a child's age and identity.
California Residential Lease Agreement: This essential document is a legally binding contract for rental agreements in California, detailing everything from rental amounts to the responsibilities of both landlords and tenants. For more information, visit PDF Documents Hub.
Driver’s License or State ID: When applying for a driver’s license or state ID, individuals often need to provide a birth certificate as proof of identity and age.

Each of these documents plays a crucial role in establishing identity and legal status, similar to the CDC U.S. Standard Certificate of Live Birth form.

↓ CDC U.S. Standard Certificate of Live Birth File

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