Pennsylvania Application for a Birth Certificate with Fees Waived for a Person Affected by an Opioid Use Disorder (HD1106F-O)
Official state formOther copy requestsForm HD1106F-OFree downloadLast verified November 10, 2026
Application for one Pennsylvania birth certificate at no charge for a person affected by an opioid use disorder who cannot pay the fee. 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, affected by an opioid use disorder
- Must be 18 or older, or an emancipated minor
- Must attest to being unable to pay the $20 fee
What to send with it
- Completed and signed application
- Photocopy of a valid government-issued photo ID, or two current documents that show your name and address
- If the address on the ID differs because you are staying at a treatment facility, halfway house or shelter: a letter on that organization's letterhead
- If you have no ID: a request on the form to be contacted
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 09/21
- Source
- Official government page