Pennsylvania Department of Health - Vital Records · Pennsylvania state form
HD105.018 Delayed Report of Live Birth
Use this form to report a Pennsylvania birth when the report is submitted more than seven years after the individual’s birth. Supporting documentary evidence is required.
- What this form is
- The Delayed Report of Live Birth is for reporting a birth that occurred in Pennsylvania when the report is submitted more than seven years after the birth. The form requests contact details, birth and parent information, and documentary evidence establishing the facts of birth. After the report is approved, the Department of Health will inform you that you can submit an Application for a Birth Certificate.
- Who needs it
- A person reporting their own birth, a parent reporting for a child under 18, or another person filing on behalf of the individual or parent.
- Why it needs a notary
- The report must be signed in front of a notary, and a commissioned online notary can notarize it. If attaching an original court order, the form must be signed but does not need notarization.
- How to submit it
- Mail the notarized report and supporting documentary evidence 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 uses the Delayed Report of Live Birth?
It is for reporting a birth that occurred in Pennsylvania when the report is submitted more than seven years after the individual’s birth. A parent may file for a child under 18.
Does the Delayed Report of Live Birth need to be notarized?
Yes. Sign the form in front of a notary; a commissioned online notary can notarize it. If you attach an original court order, the form must be signed but does not need notarization.
What happens after the report is approved?
The Department of Health will inform you after the report is accepted. To receive a birth certificate, submit an Application for a Birth Certificate after you are informed of the approval.