Pennsylvania Application for a Birth Certificate with Fees Waived for a Person Experiencing Homelessness (HD1106F-H)
Official state formOther copy requestsForm HD1106F-HFree downloadLast verified November 10, 2026
Application for one Pennsylvania birth certificate at no charge for a person experiencing homelessness, supported by an advocate. Apply in person at a Vital Records branch office or mail it to the Division of Vital Records in New Castle.
Who can use this form
- The person named on the birth record, at least 16 years old or emancipated
- A parent, for a child currently in the parent's care
- An advocate must also sign: a facility director, social worker or attorney
What to send with it
- Completed application signed by the applicant and the advocate
- The applicant's photo ID, valid or expired, if the applicant has one
- The advocate's valid government-issued photo ID
- A letter on the organization's official stationery that confirms its mailing address, the advocate's affiliation and the advocate's connection to the applicant
Where to send it
- Mail to
- Department of Health Division of Vital Records PO Box 1528 New Castle, PA 16103
- State fee
- Fee waived for one copy. The applicant attests to being unable to pay the $20 fee.
- Typical processing
- Same day to five days when ordered in person at a Vital Records branch office
- Form revision
- REV 07/22
- Source
- Official government page