VR 172 (Rev. 6/22)
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Visit nyc.gov/vitalrecords for updated processing times, order status and additional information.
(Please print clearly and ll out as much information in English as you can. Forms submitted in other languages will take longer to process.
Translations of this form are available online for reference only — please ll out the English form in English.)
Who Can Apply for a Correction?
To apply for a correction: you must be the person named on the certificate and at least 18 years old, or a
parent or legal guardian of the person named on the certificate if the person is younger than 18 years old.
The person named on the certificate must have been born within the five boroughs of NYC (Bronx, Brooklyn,
Manhattan, Queens, Staten Island).
How Do I Make a Correction?
• Start by going to Page 5 of this form and identify the type of correction that you want to make.
• Depending on the type of correction that you want to make, go to Tables A, B, C, D or E.
• Carefully read the instructions on the types of documents you will need to submit with your application.
• Next, gather the required documents and include them with your application.
• Complete all the information on Pages 2 to 4. Make sure to sign and date the form.
• You must submit a current (not expired) and signed photo identication. If the names of both parents
are on the record, both must sign the application and submit copies of their identication (ID). We accept
photocopies of ID with mailed applications. Photocopies must be clear and include the front and back
of the ID.
Documents Requirements
• You must send original documentation on letterhead or certied copies with your application. Certied copies
are documents issued by a government oce that often have a raised seal, such as birth certicates or
marriage certicates. Notarized copies, photocopies or altered documents are not accepted.
• If your documents are in a language other than English, you must obtain an ocial translation of documents
needed. Consulates outside the U.S. will often translate ocial documents for you. We also accept
translations from established translation services.
Fees: How Much Does It Cost to Make a Correction?
The NYC Department of Health and Mental Hygiene (the Health Department) charges a nonrefundable $40
application processing fee to make most corrections, plus $15 per copy for each new certicate. Where fees
apply, the application is $40 even if more than one item is corrected.
There is no fee for the following type of corrections only: Acknowledgments of Parentage/Paternity;
Orders of Parentage/Filiation/Paternity; adding a parent who was married prior to the birth of the child; adding
a child’s given name, if submitted by a parent to the Health Department within 60 days of the child’s birth;
adding a child’s given name, if submitted by a parent to the hospital within 12 months of the child’s birth;
correcting hospital errors and omissions, if submitted by the hospital where the child was born within the rst
12 months of birth.
Application for the Correction
of a NYC Birth Certificate
VR 172 (Rev. 6/22)
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Section One: What Is Your Name?
Note that you must be at least 18 years old. Print clearly and use black ink only.
FIRST NAME MIDDLE NAME LAST NAME
MAILING ADDRESS APARTMENT NUMBER
CITY STATE ZIP CODE
PRIMARY PHONE NUMBER ALTERNATE PHONE NUMBER EMAIL ADDRESS
Marital partnership status:
□ Single/never married □ Married □ Separated
□ Divorced □ Widowed □ Registered domestic partnership
Section Two: Birth Certicate Information
For this section, write what is currently listed on the birth certificate that you want to correct.
Birth certificate number: 1 5 6 - ___ ___ - ___ ___ ___ ___ ___ ___
Name on the birth certificate as it currently appears:
FIRST NAME MIDDLE NAME LAST NAME
Date of birth (mm/dd/yyyy): ______________________ Sex: □ Male □ Female □ X*
Mother’s maiden name:
FIRST NAME LAST NAME
Place of birth as it now appears on the birth certificate:
NAME OF HOSPITAL, BIRTHING CENTER OR, IF AT HOME, STREET ADDRESS, CITY, STATE, ZIP CODE
*X is a gender that is not exclusively male or female (a nonbinary gender identity).
VR 172 (Rev. 6/22)
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Section Three: What Do You Want to Correct?
Use one line per correction. We cannot accept a form with text that is crossed out or with Wite-Out on it. If you
make a mistake, use a new application form. (If adding a second parent ONLY, complete Section 4 instead.)
What do you want to correct?
What is currently listed on
the birth certificate?
What should it say on
the birth record?
Example: Child’s first name Example: Not Shown Example: Michael
Example: Date of birth Example: October 16, 2009 Example: October 19, 2009
Section Four: Second Parent Information
If you want to add the name of another parent, fill out this section. You must have been married prior to the
birth of the child. See Table B on Pages 7 and 8.
Name of the Second Parent
FIRST NAME MIDDLE NAME LAST NAME OF SECOND PARENT
Parent’s country of birth ________________________________ Sex: □ Male □ Female □ X
Second parent’s date of birth (mm/dd/yyyy): ______________________
Second parent’s age at the time of child’s birth: ________
CHILD’S LAST NAME (AS IT WILL APPEAR ON THE CERTIFICATE, EVEN IF IT WILL REMAIN THE SAME)
SIGNATURE OF SECOND PARENT DATE
VR 172 (Rev. 6/22)
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Section Five: Sign Your Application
Sign the form where appropriate. If the names of both parents are currently on the birth certificate, both must
sign if the child is younger than 18 years old.
SIGNATURE OF MOTHER/PARENT/LEGAL GUARDIAN DATE
SIGNATURE OF FATHER/PARENT/LEGAL GUARDIAN DATE
SIGNATURE OF PERSON COMPLETING THIS APPLICATION DATE
YOUR SIGNATURE (IF YOU ARE AGE 18 OR OLDER AND ARE REQUESTING A CORRECTION OF YOUR OWN BIRTH CERTIFICATE)
Warning! No person shall make a false, untrue or misleading statement or forge the signature of another on an
application required to be prepared pursuant to the New York City Health Code. A violation of the Health Code shall
be punishable as a misdemeanor. (NYC HEALTH CODE 3.19) Submitting false identification is a crime and violators
are subject to prosecution.
Fees and How to Submit Your Application
There is a nonrefundable $40 application processing fee to make most corrections,
plus $15 per copy for each new certificate up to a limit of three certificates.
For example, the cost of correcting a birth certificate and requesting two corrected copies is $70:
Processing fee = $40 + $30 for two certificates = $70 total.
Figure Out the Cost of Your Request
Nonrefundable processing fee: $40
Number of corrected birth certificates requested (maximum of 3):
Multiplied by $15 for each corrected certificate equals: $
Total amount enclosed: $
See Page 1 for applicable fees, including corrections for which the fee is waived. The certificate fee
is also waived if you enclose a certified copy of a certificate purchased within the past three months and
want to exchange it for a corrected certificate.
Please make your check or money order payable to: NYC Department of Health and Mental Hygiene.
Cash is not accepted. Walk-in customers may pay using a credit or debit card, check, or money order.
Make certain you have enclosed everything necessary (check all that apply):
□ Completed, signed application with a copy of photo ID.
If child is younger than age 18, include ID for each
parent named on the certificate.
□ One photocopy of each original or certified copy
□ Payment, if applicable
□ Original or certified documents
Mail to:
NYC Department of Health and Mental Hygiene
Corrections Unit
125 Worth Street, CN-4, Room 144
New York, NY 10013
All forms should be filled out in English, but translated forms are available online for reference only.
VR 172 (Rev. 6/22)
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What would you like to request?
Identify what you need to submit based on the following tables.
Type of correction requested What do I submit?
1 Adding or correcting a name on a birth certificate See Table A.
2 Changing your name or your child’s name on a birth certificate See Table A.
3
Correcting the parent information on a birth certificate
(names of parent, date and place of birth of parent)
See Table A.
4
Adding, changing or removing parent on a birth certificate
(includes paternity, filiation, adoption)
See Table B.
5 Changing sex/gender marker on a birth certificate See Table C.
6 Correcting an error made by the hospital See Table D.
7 Removing information from the birth record See Table E.
VR 172 (Rev. 6/22)
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Table A
I am the I want to What documents do I need?
(See description of documents below.)
Person named on the
certificate or parent(s)
of child named on the
certificate. If parent,
child must be younger
than 18 years old.
If the error was made by
the hospital, go to Table D
in this application.
1. Add or correct the first or middle name
on the birth certificate.
1, 2, 3, 4, 5 or 6
(Also see “Note for documents 1 to 6” under
the list of documents table below.)
2. Change the name on the birth certificate
(first, middle and/or last name; legal
name change).
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3. Correct the parent information on the
birth certificate (spelling of parent
names; parent date and place of birth).
7, 9 or 13
4. Correct the last name on the
birth certificate.
7a, 8, 9, 10 or 11
All documents must be dated prior to
the date of birth.
If the error was made by the hospital, go to Table D in this application.
List of documents accepted by the NYC Department of Health and Mental Hygiene
# Type of document(s) accepted
1* Immunization record showing child’s first name, date of birth, name of parent listed on the birth certificate and
the health care facility’s stamp. The immunization record must be at least 10 years old.
2* First census record taken after birth (federal or state)
3* Letter from a physician showing your date of birth and correct name. The letter must be on letterhead and
indicate that you were treated by the physician 10 or more years ago. It must include the date of your first visit
and the date of your last visit.
4* Letter from an elementary, middle or high school that you attended showing your date of birth and correct name.
The letter must indicate the dates that you were registered and must be from a school that you attended 10 or
more years ago.
5* A letter or document from a religious institution showing your date of birth and correct name. The document
must be at least 10 years old and on official letterhead.
6* Your life insurance policy showing your date of birth and correct name. The policy must be at least 10 years old.
7 Original birth certificate of the parent whose information you would like to correct.
7a Birth certificate of parent showing the correct spelling of last name. The certificate must be dated prior
to the date of birth.
8 Passport of the parent showing the correct spelling of last name. The passport must be issued prior
to the date of birth.
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Parent’s original marriage record/certificate if parents were married before the child was born. This can only
be used to correct a last name.
10 Parent’s U.S. Naturalization Certificate. The information on the naturalization certificate must match the parent
information on the birth certificate. The parent’s last name on the naturalization certificate must match the
requested correction. The naturalization certificate must be dated prior to the date of birth.
11 Birth certificate of an older sister or brother with the same parent.
12 Obtain a certified legal name change court order. If you live in NYC, you must go to Civil Court and request a legal
name change. If you live outside of NYC, go to the appropriate court in your area and request a legal name change.
The certified legal name change court order must include the date of birth, place of birth and certificate number.
13 Any of the following:
• Birth certificate of the parent whose information you would like to correct
• Birth certificate of an older sister or brother with the same parent
• Religious institution showing your date of birth, your correct name and parent’s correct name(s)
• Naturalization certificate or marriage record before the child was born; may be used to correct last name only
* Note for documents 1 to 6: Generally, a document must have been established prior to the child’s 7th birthday or it must be at least
10 years old. This helps us establish that the documentation you are submitting is legitimate. Documents should also include the
following: child’s name; listed date of birth; parent name(s).
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Table B. Adding, changing or removing parent on a NYC birth certificate
(includes Acknowledgments of Parentage/Paternity, Filiation, Adoption)
Please read this first:
The process for adding the name of a second parent to a NYC birth certificate usually depends on the marital
status of the parent(s) at the time the child was born.
Civil marriage records or other documents must be submitted with the application. In cases where the parent
has been legally divorced, the divorce record(s) also must be submitted. If relevant, a death certificate of the
deceased parent must be submitted. All records must be certified copies.
New York State recognizes marriages performed in other states, Washington D.C., and abroad. It does not
recognize common law marriage.
Note that unless there is a court order, this application form must be signed by both parents when adding a
second parent.
How do I add the name of another parent? Read this table (continues on next page) to find out what you must do.
# I am the child’s
Married at the time
of the child’s birth?
I want to add I need to
1 Mother/parent
who gave birth
Yes Spouse
(this applies to the
spouse at the time
of the child’s birth)
Complete Section 4, Page 3, of this
application (second parent information).
There is no $40 correction fee to add the
spouse. However, there is a $15 fee for
each corrected certificate.
2 Mother/parent
who gave birth
Yes, but I was not
married to my
child’s biological
father at the time
of my child’s birth.
Biological
father/parent
of the child
Go to Family Court or New York State Supreme
Court and ask for an Order of Parentage/
Filiation. Also, request that the city, state, date
of birth and sex of the parent to be added are
specified on the Order of Parentage/Filiation.
There is no $40 correction fee to add the
biological father. However, there is a $15 fee
for each corrected certificate.
3 Mother/parent
who gave birth
No Biological
father/parent
of the child
Complete Acknowledgment of Parentage
(AOP) form.
or:
Go to Family Court or New York State Supreme
Court and ask for an Order of Parentage/
Filiation. Also, request that the city, state, date
of birth and sex of the parent to be added are
specified on the Order of Parentage/Filiation.
There is no $40 correction fee to add the
biological father. However, there is a $15 fee
for each corrected certificate.
4 Mother/parent
who gave birth
No Second parent
(does not include
biological father/
parent of the child)
Complete Acknowledgment of Parentage
(AOP) form.
or:
Go to Family Court or New York State Supreme
Court and ask for an Order of Parentage/
Filiation or Order of Adoption. Also, request
that the city, state, date of birth and sex of the
parent to be added are specified on the Order
of Parentage/Filiation or Order of Adoption.
There is no $40 correction fee to add second
parent. However, there is a $15 fee for each
corrected certificate and a $40 correction fee
for Orders of Adoption.
(continued on next page)
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Table B continued. How do I add the name of another parent? Read this table to find out what you must do.
# I am the child’s
Married at the time
of the child’s birth?
I want to add I need to
5 Biological father Either Yes or No Myself See instructions for numbers 1, 2 and 3
above and complete as applicable. Consent
of birth mother/parent may be required.
6 Second parent
(does not include
biological father/
parent of the child)
No
If Yes, follow
instructions for
number 1
Myself Go to Family Court or New York State Supreme
Court and ask for an Order of Parentage/
Filiation or Order of Adoption. Also, request
that the city, state, date of birth and sex of the
parent to be added are specified on the Order
of Parentage/Filiation or Order of Adoption.
Fees are the same as in number 4 above.
How do I remove or change a parent on a NYC birth certificate?
I am the child’s
Married at the time
of the child’s birth?
I want to I need to
Parent listed on the
birth certificate
Either Yes or No Change or remove
a parent
Go to Family Court or New York State Supreme
Court to establish parentage. Ask for an Order
of Parentage to remove or change a parent.
Table C. Changing Gender Marker
# I am the I want to What do I need to do?
1 Person listed on
the certificate
Change the gender marker
on my birth certificate
Complete application and self-attestation form
(age 18 and older).
See on.nyc.gov/birthcertgenderselfattestation.
2 Parent of child listed on
the birth certificate
Change the gender marker
on my child’s birth certificate
Complete application and self-attestation form
for minors (younger than age 18).
See on.nyc.gov/birthcertgenderattestationminor.
Table D. Correcting an Error Made by the Hospital
# I am the I want to My child’s age is
currently
What do I need to do?
1 Parent listed
on my child’s
certificate
Add my child’s first
and middle name
60 days or younger Submit this application with valid ID for parent(s)
listed on the certificate. No fee.
Younger than 1 year
old but older than
60 days old
Submit this application with valid ID
for parent(s) listed on the certificate.
Regular fee applies.
2 Parent listed
on my child’s
certificate
Correct an error
made by the hospital
on my child’s
birth certificate
Child is currently
younger than
1 year old
Return to the hospital where your child was born.
Bring this application and ask them to submit a
correction to fix the error. The hospital will submit the
request electronically to the NYC Health Department.
No fee.
3 Parent listed
on my child’s
certificate
Correct an error
made by the hospital
on my child’s
birth certificate
Child is currently
younger than 18
years old but older
than 1 year old
Request a letter from the hospital where the child
was born stating that an error was made. The letter
must indicate the child’s name, date of birth and the
incorrect information as it currently appears on the
birth certificate, as well as the correct information as
it should appear. The letter must include name of the
parent(s) listed on the birth certificate.
4 Person
named
on the
certificate
Correct an error
made by the hospital
on my birth certificate.
This applies only to
the following fields:
sex, date and time of
birth, place of birth.
You are 18 years old
or older.
Request a letter from the hospital where you were
born stating that an error was made. The letter must
indicate my name, date of birth and the incorrect
information as it currently appears on the birth
certificate, as well as the correct information as it
should appear. You must also submit one of the
following: hospital worksheet, log journal or birth
records completed at time of birth.
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Table E. Removing Information From a Birth Certificate
# I am the I want to What do I need to do?
1 Person named on
the certificate or
parent(s) of the
child named on
the certificate.
If parent, child
must be younger
than 18 years old.
Remove information from the birth certificate Go to New York State Supreme Court to
request a court order to remove the information.
If it is a hospital error, see Table D.
Remove a physician’s name
A physician’s name can be removed from a
birth certificate if their medical license has been
surrendered or revoked by the New York State
Department of Health, Office of Professional
Medical conduct. Visit nyc.gov/health and search
for certificate corrections for instructions (below
the Common Corrections heading, see “How do I
remove information on the birth certificate?”).
For questions, call 311 and ask for Vital Records
assistance or email [email protected].
If outside of NYC, call 212-639-9675.
