Instructions to register your child’s birth and worksheet for creating your child's birth record

PAGE 1 of 4 OFFICE OF VITAL RECORDS 05/2020

Instructions to register your child’s birth

COMPLETE THE WORKSHEET. PROVIDE ACCURATE INFORMATION.

Registering your child’s birth is important. The information you provide on the worksheet will register

your child’s birth and name and create your child’s birth record. Some of this information will print on

your child’s legal birth certificate. Some information will help all mothers and babies get services they

need. Other information helps produce statistics that improve public health and birth outcomes. Follow

the instructions. Fill out the worksheet carefully and completely. Turn it in when you are done.

Child Information

Use this section to name your child and provide information to match the worksheet to the health

record. The name you choose for your child must meet Minnesota’s standards. This makes sure that

your child’s name fits on the birth certificate, and that public services and programs in the United States

will accept it. Names and words on birth certificates print in all capital letters.

Use:

▪ Letters from the Modern English alphabet (A-Z) to spell the name; including spaces,

hyphens (-) and apostrophes (‘) (e.g. GARCIA-OLSON, O’GARA)

▪ One, two, or three words to name your child (first, middle, and last name) - if you give

your child only one name, write it in the “last name” box on the worksheet

▪ Up to 50 characters for each of the first, middle, and last names

▪ Any word to name your child including either parent’s last name

▪ Optional last name suffixes (e.g., JR, SR, III)

Do not use:

▪ Numbers (numeric characters) (You may spell out a number as a name, e.g., TWELVE)

▪ Special characters (e.g., @, *, $) other than hyphens and apostrophes

▪ Handwritten notes, comments, symbols, or drawings

▪ Titles (e.g., KING, PRINCE, REVEREND) unless the word is used as the name

▪ Academic honorific titles (e.g., PhD, MA) after the last name unless it is part of a name

You do not need to name your child to register the birth. However, you will need to change the birth

record in the future, if you register your child as BABY GIRL or BABY BOY, or with no name. You may be

required to supply supporting documents, pay a fee for the change, and buy a new birth certificate.

You may apply for your child’s Social Security Number (SSN) by checking YES on the Worksheet for

creating your child’s birth record. If you check NO, you will have to apply for your child’s social security

number in person. Your child must have a name before the Social Security Administration will give your

child a SSN.

REGISTERING YOUR CHILD’S BIRTH - INSTRUCTIONS

PAGE 2 OF 4 OFFICE OF VITAL RECORDS 0 5 /2020

Mother or Gestational Carrier Information

In this section, report information about yourself, the pregnancy, and the birth. Some of this

information identifies you as the parent and prints on the birth certificate. Other information, without

identifying you, tracks trends and data to help public health. You must provide your Social Security

Number if you have one. Please check all race and ethnicity boxes that apply to you.

Single or Married

Marital status is important.

▪ If you are single, only your name as the mother appears on your child’s birth record. To list a second

parent on your child’s birth record, you must establish parentage. You may establish parentage in

the hospital, or later on. Ask for parentage information.

▪ If you are single, your child’s birth record and birth certificate are confidential by law. You may make

them public by checking YES when you complete the worksheet.

▪ Confidential records have restrictions. Only you, the child at age 16, the child’s legal guardian,

an individual with a court order, or the Minnesota Department of Human Services can get the

confidential record or certificate.

▪ A public record allows you and others who have a relationship to the child (e.g., grandparent,

spouse, attorney) to get information and the birth certificate.

▪ If you are married, your child’s birth record is public by law.

▪ If you are married or were married when the child was conceived, or at any time up to the birth,

your spouse’s information will be registered as part of the birth record and your spouse’s name will

be listed as a parent on your child’s birth record.

Second Parent

In this section, report information about the second parent. Some of this information identifies the second

parent and prints on the birth certificate. Other information, without identifying the second parent tracks

trends and data to help public health. You must provide the second parent’s Social Security Number if they

have one. Please check all race and ethnicity boxes that apply to the second parent.

Next steps

Check the record

After you complete the worksheet, give it to the staff. They will enter the information into the vital

records system to create your child’s birth record. Ask to see the Parent Verification printout. Check the

information carefully. Tell staff if you find mistakes.

Getting a birth certificate

After the record is final, you may purchase your child’s birth certificate at any Minnesota county vital

records office or from the Minnesota Department of Health. Birth certificates cost $26. Ask to check the

record before you buy a certificate. A birth certificate is an identity document for your child. Keep the

certificate safe.

PAGE 3 of 4 OFFICE OF VITAL RECORDS 05/2020

Worksheet for creating your child’s birth record

You are providing information to create your child’s birth record and improve public

health. Some of this information prints on the birth certificate.

Please fill out this worksheet carefully and completely.

Child

Give your child any name you choose. The name you choose will print on your child’s birth certificate in CAPITAL letters. Use the letters A-Z.

Only spaces, apostrophes (’) or hyphens (-) are allowed. You may put an apostrophe (‘) between any two letters or at the end of a name.

Child’s first name Child’s middle name Child’s last name(s) Suffix

Child’s date of birth (mm/dd/yyyy)

/ /

Child’s sex

# births this

pregnancy

(Plurality)

☐ Single ☐ Twin ☐ Triplet

If not a single birth, order born in the delivery.

Specify other

To apply for your child’s Social Security Number, check ‘Yes’. The State of Minnesota will send information to the Social Security

Administration to assign your child’s social security number. ☐ Yes ☐ No

Mother or gestational carrier information

Current first name Current middle name Current last name Suffix

First name before first marriage Middle name before first marriage Last name before first marriage Suffix

Birthplace – State or foreign country Birthplace – City

Date of birth (mm/dd/yyyy)

/ /

Physical address of residence (include city and zip code)

County of residence If not within city limits, name of township Social Security Number (xxx-xx-xxxx)

- -

Mailing address (may be different from physical address of residence)  Same as residence address

Cigarette smoking before and during pregnancy

For each three-month period to the right, enter either the number of

cigarettes or the number of packs of cigarettes smoked. IF NONE, ENTER “0"

Average number smoked per day: # of cigarettes or # of packs

3 months before pregnancy

First 3 months of pregnancy

Second 3 months of pregnancy

Last 3 months of pregnancy

Did you get food for yourself from the Women, Infants & Children (WIC) nutritional

program during this pregnancy?

☐ Yes ☐ No If yes, what month of pregnancy did you get started in WIC?

(First, second, third, etc.)

Your pre-pregnancy weight

(pounds)

Your height

(feet/inches)

Education – Check the box that best describes the highest level of school you have completed at the time of this baby’s birth.



grade or less  Associate degree (e.g. AA, AS)



– 12

grade, no diploma  Bachelor’s degree (e.g. BA, AB, BS)



High school graduate or GED finished  Master’s degree (e.g. MA, MS, MEng, Med, MSW, MBA)



Some college credit, but no degree  Doctorate (e.g. PhD, EdD) or Professional degree (e.g. MD, DDS, DVM, LLB, JD)

Hispanic – If you are not Spanish/Hispanic/Latina, check the “No” box.



No, not Spanish/Hispanic /Latina



Yes, Mexican, Mexican American/Chicana



Yes, Puerto Rican

 Yes, Cuban

 Yes, Other Spanish/Hispanic /Latina (e.g., Salvadoran, Dominican,

Colombian) (specify):

Race/Ethnicity Check all that apply.

☐ White

☐ Black or African American

☐ Somali

☐ Liberian

☐ Kenyan

☐ Nigerian

☐ Ethiopian

☐ Sudanese

☐ Ghanaian

☐ Other African (specify)

_______________________

☐ American Indian / Alaska Native

(name of enrolled or principal tribe)

_________________________

☐ Asian Indian

☐ Chinese

☐ Filipino

☐ Japanese

☐ Korean

☐ Cambodian

☐ Hmong

☐ Laotian

☐ Vietnamese

☐ Other Asian (specify)

________________________

☐ Native Hawaiian

☐ Guamanian or Chamorro

☐ Samoan

☐ Other Pacific Islander (specify)

_________________________

☐ Other Race (specify)

_________________________

PAGE 4 OF 4 OFFICE OF VITAL RECORDS 0 5 /2020

Worksheet for creating your child’s birth record

You are providing information to create your child’s birth record and to improve public health. Some of this information prints on the

birth certificate. Please complete this worksheet carefully and completely.

Single

If you are single, your child’s birth record is ‘confidential’ unless you make it ‘public’.

Do you want to make the birth record ‘public’? ☐ Yes ☐ No, leave the birth record as a confidential record

If you are single and you want the biological father’s information on your child’s birth record, you must establish parentage.

Parents who are not married to each other may sign a legal form to establish paternity for a child born to them. If you agree, you may both sign

the Minnesota Voluntary Recognition of Parentage (ROP) form to make the man the legal father. You can do this at the hospital or after leaving

the hospital. There is no fee to file an ROP with the Minnesota Department of Health (MDH). As soon as MDH receives and files the ROP, we will

put the biological father’s information on the birth record.

Do you and the biological father want to sign a Voluntary Recognition of Parentage (ROP) now? ☐ Yes ☐ No

Instead of signing the ROP, you may ask the court to establish paternity.

Married

Are you legally married now, or were you married when this child was conceived or any time up to the birth? ☐ Yes ☐ No

If you are married now or were married at any time during your pregnancy, your spouse is the legal parent of your child.

If you are married and your spouse is not the biological father of your child, your spouse can sign a Spouse’s Non-Parentage Statement

(SNPS), and you and the biological father can sign a Voluntary Recognition of Parentage (ROP) form. Upon receipt of the two forms at the

Minnesota Department of Health, the biological father’s information will replace your spouse’s information on the birth record.

Does your spouse want to complete the SNPS? ☐ Yes ☐ No

Second Parent Information

Current first name Current middle name Current last name Suffix

Complete this row only

if second parent’s name

changed with marriage

First name before first marriage Middle name before first marriage Last name before first marriage Suffix

Date of birth (mm/dd/yyyy)

/ /

Birthplace – State or foreign country Birthplace – City

Social Security Number (xxx-xx-xxxx)

- -

Mailing Address  Same as mother’s address

Education – Check the box that best describes the highest level of school that the second parent has completed at the time of this baby’s birth.



grade or less  Associate degree (e.g. AA, AS)



– 12

grade, no diploma  Bachelor’s degree (e.g. BA, AB, BS)



High school graduate or GED finished  Master’s degree (e.g. MA, MS, MEng, Med, MSW, MBA)



Some college credit, but no degree  Doctorate (e.g. PhD, EdD) or Professional degree (e.g. MD, DDS, DVM, LLB, JD)

Hispanic – If the second parent is not Spanish/Hispanic/Latino, check the “No” box.

☐

No, not Spanish/Hispanic /Latino

 Yes, Cuban



Yes, Mexican, Mexican American/Chicano

 Yes, Other Spanish/Hispanic /Latino (e.g., Salvadoran, Dominican,



Yes, Puerto Rican

Colombian) (specify):

Race/Ethnicity Check all that apply to the second parent

☐ White

☐ Black or African American

☐ Somali

☐ Liberian

☐ Kenyan

☐ Nigerian

☐ Ethiopian

☐ Sudanese

☐ Ghanaian

☐ Other African (specify)

_______________________

☐ American Indian / Alaska Native (name of

enrolled or principal tribe)

_________________________

☐ Asian Indian

☐ Chinese

☐ Filipino

☐ Japanese

☐ Korean

☐ Cambodian

☐ Hmong

☐ Laotian

☐ Vietnamese

☐ Other Asian (specify)

________________________

☐ Native Hawaiian

☐ Guamanian or Chamorro

☐ Samoan

☐ Other Pacific Islander (specify)

_________________________

☐ Other Race (specify)

_________________________