Fillable District of Columbia Birth Certificate Application (Government of the District of Columbia)

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District of Columbia Birth Certificate Application (Government of the District of Columbia)

On average this form takes 15 minutes to complete

The District of Columbia Birth Certificate Application (Government of the District of Columbia) form is 2 pages long and contains:

  • 2 signatures
  • 3 check-boxes
  • 51 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Government of the District of Columbia

BROWSE GOVERNMENT OF THE DISTRICT OF COLUMBIA (DC) FORMS

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District of Columbia
Birth Certificate Application
Please follow the instructions below when submitting your
application.
Please note: THE D.C. REGISTRAR MAY, AT ANY TIME, REQUEST ADDITIONAL DOCUMENTATION TO
HELP DETERMINE THE IDENTITY OR ELIGIBILITY OF THE APPLICANT.
1. A separate application form must be submitted for each individual certificate being requested, and a separate VitalChek
Processing Fee is required for each separate application.
("LexisNexis VitalChek Network Inc. is in partnership with the District of Columbia Dept. of Health to enable enhanced electronic processing of mail-in vital record applications.")
2. Current identification (as listed on the table below) is required for each certificate being requested. Expired IDs will not
be accepted.
Choose 1 Primary ID, OR at least 3 Secondary IDs (if Primary ID is not available)
PRIMARY ID (1)
Valid, unexpired State-issued
driver’s license
Valid, unexpired Passport
Valid, unexpired State-issued ID Card
(non-driver)
OR
SECONDARY ID
(3 or more)
W-2 Form or current, filed tax form
Current utility bill showing full name and address
Current pay stub
School ID with transcript
Work ID with photo Veteran ID
Social Security Card with signature
Notarized letter from parent listed on certificate
Voter Registration Card
Valid Department of Corrections ID Card with photo,
accompanied by probation documents or discharge papers
Court Order
Car registration or title with current name and address
Military ID or Selective Service Card Federal Government Census Record
3. Only the persons named on the certificate (Mother, Father, or Child), an immediate family member or a legal
representative are eligible to receive DC birth certificates. If you are not one of the persons named on the birth
certificate, you must also send additional documentation (as shown below) with your completed application to prove
your relationship to the person named on the certificate or your legal need to the certificate.
Relationship to Person
Named on Certificate
Additional Documentation Required
(in addition to the required identification listed above)
Sibling or Adult Child
A copy of your birth certificate
Grandparent
A copy of your child’s birth certificate
Adult Grandchild
A copy of your birth certificate, and a copy of your parent’s birth certificate which names
your grandparent
Legal Guardian
A copy of the valid guardianship papers certified by the court naming you as legal guardian
Social Worker
A copy of your work ID, and
A letter from the parent (or legal guardian), a court order, or a letter from your
organization (on official letterhead, signed by a supervisor) stating your professional
relationship to the person named on the certificate being requested
Attorney
A signed document stating you have been retained by your client (such as a retainment or
engagement letter), documentation establishing a legal or tangible interest in the record
(such as court paperwork), or a letter (on official letterhead) stating your professional
relationship to the person named on the certificate being requested
Other
Documentation providing legal, tangible interest in the certificate being requested
4. If the record you requested is not located, a “Certificate of Search” will be issued. As the request was processed and
the certificate was searched for, both the Agency Certificate Fee and the VitalChek Processing Fee are non-refundable.
Departmen
t of Health
Vital Records Division
ATTN: New Applications Dept.
899 North Capitol St., NE, 1
st
Floor
Washington, DC 20002
For expedited order placement
and processing please visit
www.VitalChek.com.
5. Please mail your completed application, along with identification and additional documentation (if required), to:
6. Please allow 5 to 7 business days for your application to be received prior to calling our customer service department with
any questions about your application. We can be reached at 1-877-572-6332.
District of Columbia
Birth Certificate Application
Full Name of Child at Time of Birth (Certificate Holder)
first name middle name last name suffix
Father’s Full Name
first name middle name last name suffix
Mother’s Full Name
first name middle name maiden last name
Date of Birth (MM/DD/YYYY) Hospital Gender Male Still Living Yes
Female No
Reason for Request
Your Full Name (Applicant)
first name middle name last name suffix
Your Street Address City State Zip Code
Your Relationship to Person Named on Certificate E-mail Address (for communication & status updates) Daytime Phone Number
Name and Address to Send Certificate (if different than noted above)
first name middle name last name suffix
Ship To Address City State Zip Code
Your Signature (Applicant) Date of Application
Price / ea
Total
A Number of copies: (total for all copies below)
$ _______
First copy
$23.00
$23.00
Additional copies (max of 5)
x $23.00 ea
B
Select Delivery Method (choose one):
•
UPS will not deliver to a P.O. Box
•
Processing time may take 7-10 business days
$_______
UPS Next Day Air
$20.00
UPS to Alaska, Hawaii, Puerto Rico
$40.00
UPS to Canada or Mexico
$26.00
UPS Worldwide Expedited
$36.50
U.S. Postal Service Regular Mail
$0.00
C Processing & Handling: (non-refundable)
$ _6.00_
VitalChek Processing Fee
$6.00
$6.00
TOTAL AMOUNT DUE = A + B + C
$ _________
Please mail your completed form, along with ID and additional documentation (if required), to:
Department of Health, Vital Records Division
ATTN: New Applications Dept.
899 North Capitol St., NE, 1
st
Floor
Washington, DC 20002
FOR VITALCHEK USE ONLY
Order # __________________
STEP 1: CERTIFICATE INFORMATION
STEP 2: YOUR INFORMATION AND SHIPPING ADDRESS
Restriction on Access to Birth Certificates: Pursuant to D.C. Official Code Sec. 7-220, the Vital Records Division may issue a certified
copy of a birth certificate ONLY to an applicant having a direct and tangible interest in the requested birth certificate.
NOTE: This form should be used ONLY by a person named on the certificate, an immediate family member, guardian or legal representative.
STEP 3: COST
STEP 4: PAYMENT INFORMATION
Select Payment Method: Submit separate payment for each Application
Credit Card Personal Check Money Order
DO NOT SEND CASH
Credit Card Information:
(if paying by Credit Card)
Credit Card Number Expiration Date
Cardholder’s Signature Date
Charges will appear on your Credit Card statement as: VCN DC VITAL RECORDS
If paying by check or money order, make payable to VITALCHEK.
STEP 5: MAIL YOUR COMPLETED FORM
For expedited order placement
and processing pleas
e visit
www.VitalChek.com.
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District of Columbia Birth Certificate Application (Government of the District of Columbia)

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Completed 26 January 2022

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