Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD002291 Request to Modify a Teenage Child’s Birth Record
Use form HD002291 to request a modification to a birth record for a child who is at least 14 and under 18 years old.
- What this form is
- A parent or other eligible person can use form HD002291 to request changes to a teenager’s birth record. The form collects contact, identification, birth record, and requested modification details. Depending on the change, supporting documents may be required. Each required signer must sign Part 6 in front of a notary, and the completed request is mailed to the Department of Health’s Birth Registry.
- Who needs it
- A parent or eligible person requesting a modification to a birth record for a child who is at least 14 and under 18 years old.
- Why it needs a notary
- The required signatures in Part 6 must be notarized. This can be done online with a commissioned online notary.
- How to submit it
- Mail the completed form and applicable supporting 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 form HD002291?
The form is for requesting a modification to the birth record of a child who is at least 14 years old and less than 18. It cannot be used for changes due to adoption or parentage.
Does form HD002291 need to be notarized?
Yes. The form says the required signers must sign Part 6 in front of a notary. You can complete this step online with a commissioned online notary.
Where do I mail the completed form?
Mail it and applicable supporting documents to the Department of Health, Bureau of Health Statistics and Registries, ATTN: Birth Registry, 555 Walnut St., 6th Floor, Harrisburg, PA 17101-1934.