Download CDC U.S. Standard Certificate of Live Birth Template

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 form captures essential information such as the baby's name, date of birth, and the parents' details, serving as a vital record for various legal and administrative purposes. Understanding how to accurately fill out this form is important for ensuring proper registration and documentation of a child's birth.

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Misconceptions

Understanding the CDC U.S. Standard Certificate of Live Birth form can be challenging. Many people hold misconceptions about this important document. Here are nine common misunderstandings:

It is the same as a birth certificate issued by the state. Many believe that the CDC form is the official birth certificate. However, it is a standard form used to collect data that states then use to create the official birth certificate.
All states use the same version of the form. While the CDC provides a standard template, each state may modify the form to meet local laws and requirements. Therefore, variations exist across different states.
Only hospitals can fill out the form. This is not entirely accurate. While hospitals typically complete the form, parents can also provide necessary information, especially if the birth occurs outside a medical facility.
The form is only necessary for legal purposes. Some people think the form is solely for legal documentation. In reality, it also serves public health purposes, helping to track birth statistics and health trends.
Once submitted, the information cannot be changed. This is a misconception. Parents can request corrections to the information on the form if they discover errors after submission.
There is a strict deadline for submitting the form. While timely submission is encouraged, states often allow a grace period for parents to submit the form after the birth of their child.
All information on the form is public. Many assume that all details on the birth certificate are accessible to anyone. However, access to this information is restricted to protect privacy.
The form is only for newborns. Some individuals think the form only applies to infants. However, it can also be used for children adopted or born through surrogacy.
Filling out the form is optional. This is not true. In most states, completing and submitting the birth certificate form is a legal requirement after a child is born.

These misconceptions can lead to confusion and misinformation. Understanding the facts surrounding the CDC U.S. Standard Certificate of Live Birth form is crucial for parents and guardians navigating the birth registration process.

File Details

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 states to ensure uniformity in birth data collection and reporting.
Data Collection	Information collected includes the baby's name, date and place of birth, and details about the parents.
Legal Requirement	All states require the completion of this form for legal recognition of a birth.
State-Specific Forms	While the CDC form is standardized, each state may have additional requirements governed by state laws.
Filing Deadline	Most states require the birth certificate to be filed within a specific timeframe, often within 30 days of birth.
Access to Records	Birth certificates are typically accessible to parents and legal guardians, with certain restrictions on public access.

Key takeaways

When filling out and using the CDC U.S. Standard Certificate of Live Birth form, consider these key takeaways:

Accuracy is essential. Ensure all information is correct to avoid complications in obtaining a birth certificate.
Use clear handwriting. If filling out the form by hand, print legibly to ensure that all details are easily readable.
Provide complete information. Fill in all required fields, including details about the parents, to prevent delays in processing.
Check for specific state requirements. Some states may have additional information or documentation needed, so verify local guidelines.
Submit promptly. File the completed form as soon as possible after the birth to ensure timely issuance of the birth certificate.
Keep a copy. Retain a copy of the completed form for your records before submitting it to the appropriate office.
Understand the purpose. The birth certificate serves as an official record and is often required for identification, school enrollment, and other legal purposes.

Dos and Don'ts

When filling out the CDC U.S. Standard Certificate of Live Birth form, it is important to ensure accuracy and completeness. Here are some guidelines to help you through the process:

Do read the instructions carefully before starting.
Do use black or blue ink for clarity.
Do provide all required information, including the full names of both parents.
Do double-check all entries for spelling and accuracy.
Don't leave any required fields blank.
Don't use correction fluid or tape on the form.
Don't sign the form until all information is complete.
Don't submit the form without a witness if required.
Don't forget to keep a copy for your records.

Following these guidelines will help ensure that the form is processed smoothly. If you have questions, consider reaching out to your local vital records office for assistance.

Common mistakes

Failing to provide accurate parental information. This includes names, addresses, and dates of birth. Inaccuracies can lead to delays in processing.
Not including the time of birth. This detail is crucial for the official record and can sometimes be overlooked.
Leaving out the place of birth. The specific location, including the hospital or facility name, is necessary for the certificate.
Using incorrect spelling for names. Names should be spelled correctly to avoid issues in identification and legal matters.
Not signing the form. Both parents must provide their signatures; otherwise, the application will be incomplete.
Forgetting to include the mother's maiden name. This detail helps establish lineage and is a required piece of information.
Using illegible handwriting. Clear and readable handwriting is essential to ensure that all information is correctly interpreted.
Neglecting to check for additional requirements specific to their state. Some states may have unique documentation needs.
Not providing contact information for follow-up. Including a phone number or email can help resolve any questions that may arise.
Submitting the form without double-checking for errors. A thorough review can prevent minor mistakes from causing significant delays.

What You Should Know About This Form

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 about the newborn, including the child's name, date of birth, place of birth, and details about the parents.
Who needs to complete the birth certificate form?
The birth certificate form should be completed by the parents or guardians of the newborn. In some cases, hospital staff may assist in filling out the form. It's important to ensure that all information is accurate and complete to avoid issues later.
How do I obtain a copy of the birth certificate?
To obtain a copy of the birth certificate, you must 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 home address)
- Parents' names and addresses
- Parents' dates of birth
- Parents' places of birth
Can the information on the birth certificate be changed later?
Yes, certain information on the birth certificate can be amended after it is filed. Common changes include correcting spelling errors or updating parental information. Each state has specific procedures for making these changes, often requiring documentation to support the request.
How long does it take to receive the birth certificate?
The time it takes to receive a birth certificate can vary by state and the method of request. Typically, it can take anywhere from a few days to several weeks. Expedited services may be available for an additional fee.
Is the birth certificate necessary for other legal processes?
Yes, a birth certificate is often required for various legal processes. It may be needed for obtaining a Social Security number, enrolling in school, applying for a passport, or proving identity. Keeping a copy on hand is advisable.
What should I do if I lose the birth certificate?
If the birth certificate is lost, you can request a replacement from the vital records office in the state where the birth occurred. You will need to provide identification and may need to fill out a request form. There may also be a fee for the replacement certificate.

CDC U.S. Standard Certificate of Live Birth Example

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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