CDC U.S. Standard Certificate of Live Birth Form

The CDC U.S. Standard Certificate of Live Birth form is an official document used to record the details of a newborn's birth in the United States. This certificate serves as a vital record, providing essential information for legal identification, citizenship, and various administrative purposes. Understanding its components and significance can help parents navigate the important steps following the arrival of their child.

Access CDC U.S. Standard Certificate of Live Birth Here

The CDC U.S. Standard Certificate of Live Birth form plays a crucial role in documenting the birth of a child in the United States. This official form captures essential information about the newborn, including the child's name, date of birth, and place of birth. It also records vital details about the parents, such as their names, addresses, and birthplaces, which are important for legal and statistical purposes. The form includes sections for the attending physician or midwife to provide their information and certify the birth. Furthermore, it is designed to ensure uniformity across states, making it easier to track birth statistics and health trends nationwide. Understanding the significance of this form can help parents navigate the process of registering their child's birth and ensure that all necessary information is accurately reported. By completing this form, parents contribute to a vital public health record that supports various governmental and health initiatives.

Common Questions

What is the CDC U.S. Standard Certificate of Live Birth form?

The CDC U.S. Standard Certificate of Live Birth form is an official document used to record the birth of a child in the United States. This form captures essential information such as the child's name, date and place of birth, and the parents' details. It serves as a legal record of the birth and is necessary for obtaining a birth certificate, which is often required for various purposes, including applying for a Social Security number and enrolling in school.

Who is responsible for completing the form?

The responsibility for completing the Certificate of Live Birth typically falls on the attending physician or midwife. In cases where neither is available, a parent or guardian may fill out the form. It is crucial that the information provided is accurate and complete, as any discrepancies can lead to complications in obtaining the official birth certificate.

How is the information on the form used?

The information collected on the Certificate of Live Birth is used for multiple purposes. It helps public health officials monitor birth trends and health statistics, which can inform health policy and programs. Additionally, the data is vital for demographic studies and can assist in resource allocation for maternal and child health services. Furthermore, the form is a key document for parents to establish their child's identity and citizenship.

What should I do if there is an error on the Certificate of Live Birth?

If an error is discovered on the Certificate of Live Birth, it is important to address it promptly. Parents should contact the vital records office in the state where the birth occurred. Each state has its own process for correcting errors, which may involve submitting a request along with supporting documentation. Corrections can usually be made for minor errors, such as misspellings, but more significant changes might require additional steps.

Can the Certificate of Live Birth be obtained online?

In many states, parents can request a copy of the Certificate of Live Birth online through the state’s vital records office website. However, the availability of online services varies by state. It is advisable to check the specific requirements and procedures for obtaining the certificate in your state, as some may require in-person requests or mailed applications. Fees may also apply for obtaining copies of the certificate.

Key takeaways

When filling out and using the CDC U.S. Standard Certificate of Live Birth form, there are several important points to consider:

Accurate Information: Ensure that all information provided is accurate and complete. This includes details about the baby, parents, and the birth event itself.
Signature Requirement: The form must be signed by the attending physician, midwife, or other authorized personnel to be considered valid.
Submission Timeliness: Submit the completed certificate to the appropriate state or local vital records office promptly, as there are deadlines for registration.
Importance of the Document: The certificate serves as an official record of the birth, which is essential for obtaining a birth certificate and can be important for legal, educational, and medical purposes.

Form Properties

Fact Name	Description
Purpose	The CDC U.S. Standard Certificate of Live Birth form is used to record the birth of a child in the United States.
Standardization	This form provides a uniform method for documenting vital statistics across all states, ensuring consistency in data collection.
State-Specific Laws	Each state has its own laws governing the use of the birth certificate form, often found in state vital records statutes.
Importance	The information collected on this form is crucial for public health, demographic research, and establishing identity.

Misconceptions

The CDC U.S. Standard Certificate of Live Birth form is a crucial document for recording vital information about a newborn. However, several misconceptions surround this form. Below are ten common misconceptions, along with explanations to clarify them.

All states use the same form.
While the CDC provides a standard format, each state may have its own version with specific requirements and variations.
The form is only for U.S. citizens.
The certificate can be issued for any live birth occurring in the United States, regardless of the parents' citizenship status.
Only hospitals can file the form.
While hospitals often handle the filing, parents can also submit the form directly, especially in home birth situations.
The form is not necessary for legal purposes.
The Certificate of Live Birth is essential for establishing identity, securing a Social Security number, and enrolling in school.
Corrections to the form cannot be made.
Corrections can be made, but they typically require specific documentation and may vary by state.
The form is only needed immediately after birth.
While it is best to file it promptly, there is often a grace period during which the form can still be submitted.
Parents can choose any name for their child on the form.
There may be restrictions on names based on state laws, including rules against certain symbols or offensive words.
Once filed, the information cannot be updated.
Parents can request updates to certain information, such as name changes, but must follow specific procedures.
The form is only relevant for medical records.
The Certificate of Live Birth serves multiple purposes, including legal identification and citizenship verification.
All information on the form is public.
While some details may be accessible, many aspects of the form are protected under privacy laws.

Understanding these misconceptions can help parents navigate the process of filing the Certificate of Live Birth more effectively.

CDC U.S. Standard Certificate of Live Birth Preview

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.

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Common mistakes

Incorrect Information: One common mistake is providing inaccurate details about the parents or the child. This includes misspellings of names, incorrect dates of birth, or wrong Social Security numbers. Double-checking all information before submission can help prevent errors.
Missing Signatures: Both parents are typically required to sign the form. Omitting one or both signatures can lead to delays in processing. Ensure that all necessary signatures are present before submitting the form.
Failure to Include Required Documents: Some states require additional documents to accompany the birth certificate application, such as proof of identity or residency. Not including these documents can result in rejection of the application.
Incorrect Filing Fees: Each state has its own fee structure for processing birth certificate applications. Submitting an incorrect amount can lead to delays. Check the specific requirements for your state to ensure the correct fee is included.
Not Keeping Copies: After filling out the form, some individuals forget to make copies of the completed application. Keeping a copy can be crucial for tracking the application status or resolving any issues that may arise.

Dos and Don'ts

When filling out the CDC U.S. Standard Certificate of Live Birth form, it is essential to follow specific guidelines to ensure accuracy and compliance. Below is a list of things to do and avoid during the process.

Do provide accurate information for all required fields.
Do use black or blue ink to complete the form.
Do double-check all entries for spelling and numerical accuracy.
Do ensure that the form is signed by the appropriate person.
Don't leave any required fields blank; fill them out completely.
Don't use correction fluid or tape on the form.
Don't submit the form without reviewing it for completeness.

Following these guidelines will help ensure that the Certificate of Live Birth is processed smoothly and without delays.

Similar forms

The Certificate of Death is a document that records the details surrounding an individual's death. Similar to the Certificate of Live Birth, it serves as an official record issued by a government authority. Both documents include critical information such as the individual's name, date of the event, and place of occurrence. They are essential for legal purposes, such as settling estates or claiming benefits, and must be filed with the appropriate state or local agency.

The Marriage Certificate is another important document that shares similarities with the Certificate of Live Birth. It verifies the legal union between two individuals and includes key details such as the names of the parties, the date of the marriage, and the location where the ceremony took place. Like the birth certificate, it is an official record that is often required for various legal processes, including name changes and spousal benefits.

An Employee Handbook form serves as a comprehensive document that outlines a company's policies, procedures, and expectations for its employees. It is essential for fostering a positive workplace culture and ensuring compliance with legal obligations. Providing clear guidelines helps employees understand their rights and responsibilities within the organization, which is a principle advocated by resources like Top Forms Online.

The Divorce Decree documents the legal dissolution of a marriage. This document, much like the Certificate of Live Birth, is issued by a court and includes pertinent information such as the names of the parties involved, the date of the divorce, and any terms related to custody or property division. It serves as an official record that may be needed for future legal matters, including remarriage or child support enforcement.

The Adoption Certificate is issued when a legal adoption is finalized. This document is similar to the Certificate of Live Birth in that it establishes a legal relationship between the adoptive parents and the child. It includes the names of the adoptive parents, the adopted child's name, and the date of the adoption. This certificate is crucial for establishing the child's identity and legal status within the family.

The Social Security Card is a unique document that provides an individual with a unique identification number for social security purposes. While it does not record life events like birth or marriage, it is similar in that it is an official government-issued document. Both the Social Security Card and the Certificate of Live Birth are essential for accessing government services, applying for jobs, and verifying identity.

The Passport serves as an official document that verifies an individual's identity and citizenship. It contains information similar to that found on the Certificate of Live Birth, such as the name, date of birth, and place of birth. Both documents are critical for travel and identification purposes, and they must be issued by a government authority to be considered valid.