Pennsylvania Name Redaction Request Form for Birth Parents (HD02046F)
Official state formAdoptionForm HD02046FFree downloadLast verified November 10, 2026
Lets a birth parent ask the Pennsylvania Department of Health to remove their name from the noncertified copy of an adoptee's original birth record, or to withdraw a redaction request filed earlier. Mail it to the Birth Registry in Harrisburg.
Who can use this form
- A birth mother or birth father listed on the original birth record
- Each birth parent files a separate form
What to send with it
- Completed form signed in front of a notary
- Two forms of identification: a valid government-issued photo ID plus a second ID such as a utility bill, pay stub or insurance card
- To redact a name: form CY 910 must be filed with the Pennsylvania Adoption Information Registry at the Department of Human Services, with at least Sections I, IIa or IIIa, and VI completed
Where to send it
- Mail to
- Department of Health Bureau of Health Statistics & Registries Birth Registry 555 Walnut Street, 6th Floor Harrisburg, PA 17101-1934
- State fee
- Not provided
- Typical processing
- Not provided
- Form revision
- REV 3/2018
- Source
- Official government page