× The federal government has shut down due to the failures of the President and Congress to continue government funding. Millions of Californians receiving benefits from state programs may be impacted. For now, California’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) will continue to provide services and enroll eligible families as long as funding is available. No new federal funding to California WIC will be provided until the President and Congress take action. Families should continue to use their WIC benefits and attend their WIC appointments. This information is subject to change, so please monitor the California WIC website for updates.

Please be wary of potential highly partisan political messaging while visiting federal government websites for information related to the federal government shutdown.

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Center for Health Statistics and informatics

*** Effective June 18, 2022 the Amendment Request Portal (ARP) will be used to create the Court Report of Adoption (VS 44) Form ***

​​Vital Records, Data and Statistics Forms

VS 12, 13 E (PDF) - Application for Certified Copy of Fetal Death Record or Still Birth Record

VS 12, 13 E SP (PDF) - Application for Certified Copy of Fetal Death Record or Still Birth Record

VS 20 (PDF) - Sworn Statement

VS 20 SP (PDF) - Sworn Statement

VS 21 (PDF) - Application to Amend a Birth Record-Adjudication of Facts of Parentage | Sample (PDF)

VS 22 (PDF) - Acknowledgement of Paternity/Parentage | Sample (PDF)

VS 23 (PDF) - Amendment of Birth Record to Reflect Court Order Change of Name

VS 24 (PDF) - Affidavit to Amend a Record | Sample (PDF)

VS 24 A (PDF) - Physician/Coroner's Amendment

VS 24 C (PDF)- Affidavit to Amend a Marriage Record | Sample (PDF)

VS 44 (WEB FORM) - Court Report of Adoption | ARP Instruction Presentation (PDF)

VS 85 (PDF) - Delayed Registration of Birth

VS 105 (PDF) - Court Ordered Delayed Registration of Fetal Death

VS 107 (PDF) - Supplemental Name Report-Birth

VS 108 (PDF) - Court Order Delayed Registration of Birth | Sample (PDF)

VS 109 (PDF) - Court Ordered Delayed Registration of Death | Sample (PDF)

VS 111 (PDF) - Application for Certified Copy of Birth Record

VS 111 SP (PDF) - Application for Certified Copy of Birth Record

VS 112 (PDF) - Application for Certified Copy of Death Record

VS 112 SP (PDF) - Application for Certified Copy of Death Record

VS 113 A (PDF) - Application for Certified Copy of Marriage Record

VS 113 A SP (PDF) - Application for Certified Copy of Marriage Record

VS 113 B (PDF) - Application for Certified Copy of Divorce Record

VS 113 B SP (PDF) - Application for Certified Copy of Divorce Record

VS 122 (PDF) - Court Ordered Delayed Certificate of Marriage | Sample (PDF)

VS 124 (PDF) - Power of Attorney-California Marriage License

VS 140 (PDF) - Request Vital Records Forms

VS 146 (PDF) - Application for Tabulated California Vital Records Data

VS 147 (PDF) - Application for CDPH Programs Surveillance Use Only

VS 148 (PDF) - CDPH Program Request for OSHPD Data 


Other Vital Records Forms

CDPH 9051 (PDF) - California Integrated Vital Records System Account Registration Form

CDPH 9052 (PDF) - California Integrated Vital Records System Account Modification Request

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