New York State Department of Health Edition DOH-4380 (09/19) 2 pages New York

Form DOH-4380 — Mail-in Application for Copy of Birth Certificate (New York State)

Order a certified New York State birth certificate by mail, for a birth outside New York City.

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Form DOH-4380 · Mail-in Application for Copy of Birth Certificate (New York State, outside NYC)
The official New York State Department of Health form, edition DOH-4380 (09/19) — blank
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Form DOH-4380 (2019) Mail-in Application for Copy of Birth Certificate (New York State, outside NYC) — page 1 of 2
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Form DOH-4380 (2019) Mail-in Application for Copy of Birth Certificate (New York State, outside NYC) — page 2 of 2
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Fill this form online Blank PDF from New York State Department of Health

What is Form DOH-4380?

Form DOH-4380 is the New York State Department of Health's mail-in application for a certified copy of a birth certificate. It covers births anywhere in New York State except the five boroughs of New York City and Long Island Jewish Medical Center, whose records are held by New York City instead.

The application is for the person named on the certificate or that person's parent. You give the details of the birth record, say why you need it, and enclose a copy of your ID with a check or money order. Each certified copy costs $30, and the fee isn't refunded if no record is found. In that case you receive a No Record Certification. Genealogy requests use a different process.

FileIt fills the answers onto the Department of Health's own PDF. It pre-fills the name and date of birth from the person's record in your family vault, works out the fee from the number of copies, and saves the finished application to that person's folder. You print it, sign it, and mail it with your ID copies and payment.

Who can apply
The person named on the birth certificate, or that person's parent.
Covers
Births in New York State outside New York City.
Fee
$30 per certified copy, by check or money order payable to the New York State Department of Health.
Mail to
NYS Department of Health, Bureau of Vital Records Certification Unit, PO Box 2602, Albany, NY 12220-2602.
Edition
DOH-4380 (09/19)

Who needs to fill out Form DOH-4380?

  • Adults born in upstate New York or on Long Island (outside NYC) who need a certified birth certificate.
  • Parents ordering a certified copy of their child's New York State birth certificate.
  • People applying for a passport, driver's license, Social Security, school entry or a marriage license who need proof of birth.
  • Families with a foreign-born adopted child who need a copy of the Certificate of Birth Data.

When to use Form DOH-4380

  • When you want to order by mail rather than online or by phone. The form points to VitalChek for expedited orders.
  • Only for births outside the five NYC boroughs. NYC births are handled by the city's own vital records office.
  • Not for genealogy requests, which the Department of Health handles separately.
  • One application per record, so a family ordering several certificates fills in one for each.

What you need before you start

  • The full name on the birth certificate, the date of birth and the town, city or village of birth.
  • The mother or parent's name before marriage, and the father or parent's name if listed.
  • The hospital name and certificate or local registration numbers, if you know them.
  • A copy of one current photo ID with your signature, or copies of two documents showing your name and address.
  • A check or money order for $30 per copy.
  • A copy of your passport as well, if you're applying from a country that requires a U.S. passport for travel.

What’s on Form DOH-4380

The 2019 edition has 2 pages. FileIt asks for it in 5 parts:

  1. The birth record you wantApplicant
  2. Why you need itApplicant
  3. You, the applicantApplicant
  4. Copies and feeApplicant
  5. Send the record to someone elseApplicant

How to fill out Form DOH-4380, step by step

1 The record

Enter the name exactly as it appears on the birth certificate, the date and place of birth, and any hospital or record numbers you know.

2 Parents' names

Give the mother or parent's birth name before marriage, and the father or parent's name as listed on the certificate.

3 Reason

Tick one reason, such as passport, school entrance or court proceeding. Choose Other to describe something else in a few words.

4 Relationship and applicant

Say how you're related to the person on the record (enter Self for your own), then give your printed name, address and phone number.

5 Copies and delivery

Enter how many certified copies you want and FileIt shows the total. Switch on the delivery part only if the record should go to another name or address.

Common mistakes to avoid

  • Using this form for a birth in New York City, which the state office doesn't hold.
  • Forgetting to sign the application before mailing it.
  • Leaving out the ID copies, or sending an expired photo ID.
  • Sending cash. Only a check or money order is accepted, drawn on a U.S. bank if sent from abroad.
  • Asking for delivery to a P.O. Box or someone else without the notarized statement and driver's license copy the form requires.

After you fill it out

Print the application, sign it, and mail it with your ID copies and payment to the Bureau of Vital Records in Albany by first class, registered, certified or Priority Mail.

If the Department finds no record, you receive a No Record Certification and the fee is kept.

When the certified copy arrives, scan it into the person's FileIt folder so it's on hand for the next passport or license application.

Keep a copy of the application and your check or money order details until the certificate arrives.

Fill out Form DOH-4380 online with FileIt

  1. Pick the person. Choose someone from People and FileIt fills in their name, date of birth, address and other details it already knows.
  2. Answer plain-language questions. One part of the form at a time, with the official help text beside each question — 35 fields in all. Your answers save as you go.
  3. Check the live preview. Watch your answers land on the real New York State Department of Health form, and let FileIt do any worksheet arithmetic.
  4. Generate the official PDF. FileIt prints your answers into the agency’s own PDF and files it in that person’s folder in your vault.

FileIt fills the form — it never files or submits anything for you. Deliver the finished form to whoever asked for it, the way the form’s instructions say.

Start Form DOH-4380 now — it’s free

Form DOH-4380: frequently asked questions

Can I use DOH-4380 for a birth in New York City?

No. The form says not to use it for births in the five boroughs of New York City or at Long Island Jewish Medical Center. Those go to New York City's vital records office.

How much does a copy cost?

The form lists $30 per certified copy by mail, so two copies are $60. FileIt totals it for you.

What ID do I need to send?

A copy of one current photo ID with your signature, such as a driver license, non-driver ID or passport. Without one, send copies of two documents with your name and address, such as a utility bill or a recent letter from a government agency.

Who can order a New York State birth certificate with this form?

The person named on the certificate or that person's parent. An attorney applying for a client gives the client's name and relationship on the form.

Can I get it faster?

The form points to VitalChek (www.VitalChek.com or 877-854-4481) for expedited ordering and processing.

Does FileIt mail the application for me?

No. FileIt fills the official PDF and keeps a copy in your vault. You sign and mail it yourself.

Can I send the record to someone else?

Yes, but for delivery to a P.O. Box or a third party the form requires a notarized statement signed by the applicant and a copy of the applicant's driver's license.

Can I use this form for genealogy research?

No. The form says genealogy requests go through a separate Department of Health process.

What if I don't know the certificate number?

Leave it blank. The birth certificate number, hospital and local registration number are only needed if you know them.

Official sources

FileIt is not affiliated with or endorsed by New York State Department of Health or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-19.

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