Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD002272 Request to Modify an Infant’s Birth Record
Use form HD002272 to request changes to a child’s Pennsylvania birth record before the child’s first birthday. The form covers infant and parent information modifications.
- What this form is
- A parent or eligible person uses form HD002272 to request changes to an infant’s birth record when the infant is younger than one year old. It collects contact, identification, birth-record, and requested-change information. Include applicable documentary evidence and the required signatures. A notarized signature is required when the infant’s or a parent’s last name is changing and no court order has been issued to effect that change.
- Who needs it
- A parent of an infant under one year old, or an eligible person with sole custody and applicable court orders, requesting a birth-record modification.
- Why it needs a notary
- A signature must be notarized if the infant’s or a parent’s last name is changing without a court order. This can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form and applicable documents to the Pennsylvania Department of Health, Bureau of Health Statistics and Registries, ATTN: Birth Registry, 555 Walnut St., 6th Floor, Harrisburg, PA 17101-1934.
Questions
Who can use this form?
The form is for requests to modify an infant’s birth record when the infant is younger than one year old. It cannot be used for changes due to adoption or parentage changes.
Does this form need to be notarized?
A signature must be notarized if the infant’s or a parent’s last name is changing and a court order has not been issued to effect the change. A commissioned online notary can notarize the signature online.
Where do I mail the completed form?
Mail it to the Pennsylvania Department of Health, Bureau of Health Statistics and Registries, ATTN: Birth Registry, 555 Walnut St., 6th Floor, Harrisburg, PA 17101-1934.