Requests for Verification of Vital Records

The “Request for Verification” form CW 2200 must be given to the applicant/recipient when verification is needed to establish eligibility for CalWORKs and CalFresh cases. The CW 2200 may also be used when requesting verification for Medi-Cal only or cash-linked Medi-Cal cases; however, it is not a required form for Medi-Cal purposes.

Payment of Fees

W&I Code Section 11275.10(b) and EAS 40-126.332

For the CalWORKs program, if it is necessary to pay a fee imposed by a third party to obtain the verification, the county must pay that fee on behalf of the applicant or recipient.

Birth/Death/Marriage Certificate Requests

The County of Santa Clara, Office of the County Clerk-Recorder maintains birth and death certificates for all the people born and who have died in the County of Santa Clara, extending back to 1873. They also maintain Marriage Certificates from 1850 to the present day. To request a certified copy of a birth/death/marriage certificate, EWs will complete the “Verification of Birth, Death and Marriage” (SCD 109) and submit it to designated clerical staff.

“Verification of Birth, Death and Marriage” (SCD 109)“Verification of Birth, Death and Marriage” (SCD 109)

SCD 109 top

SCD 109 bottom

“Application for Verification of Birth, Death or Marriage” (SCD 58)

Clerical staff will use the information from the completed SCD 109 to complete an “Application for Verification of Birth or Death” form (SCD 58)“Application for Verification of Birth or Death” form (SCD 58).

SCD 58

Clerical staff will request certified copies for SSA related purposes by checking the “Birth Certificate for SSA internal use only” box on the SCD 58 request form.This version will be stamped “for governmental use only” and may not be provided to the client. Certified copies for clients may be obtained by checking the “Birth Certificate for client/outside use” box on the SCD 58. This version shall only be requested if specifically requested by the worker when it is needed by the client to obtain services related to eligibility (i.e., ID, Social Security, Immigration, etc.)

Note: The cost of the “Birth Certificate for SSA internal use only” is significantly less than the “Birth Certificate for client/outside use” and should be requested whenever possible.

 

  1. Ensure all highlighted sections of the SCD 58highlighted sections of the SCD 58 are filled out.

    highlighted SCD 58

  2. Enter data from the SCD 58 into the “DEBS-In County Vital Statistics Request Control Log –FY2_”. In the Type column, enter: BI (For SSA Internal use only) and BO (Outside use)In the Type column, enter: BI (For SSA Internal use only) and BO (Outside use).

    Type column

  3. Highlight filled out data, select "Sort & Filter,"select "Sort & Filter," "Custom Sort," "Sort by," "Worker No.," "Add Level," "Sort by," and "Certificate Name"; then click "OK."

    sort and filter

    custom sort

  4. Number each line according to "Custom Sort."Number each line according to "Custom Sort."

    number each line

Note: “Doe, John 1” is the same case and is numbered accordingly.

  1. Select the data entered above and press "Print," go to "Settings," select the drop-down arrow, and choose "Print Selection.""Settings," select the drop-down arrow, and choose "Print Selection."

    Excel PrintPrint Selection


  2. Print “In County BIRTH Sworn Statement” and have the supervisor fill out accordingly (click to see exampleclick to see example).

    Sworn Statement

  3. Place the filled out SCD 58 forms according to the “DEBS-In County Vital Statistics Request Control Log –FY202_” and number each page on the top left corner.
  4. Put pages together in the following order:
    1. Sworn Statement
    2. DEBS-In County Vital Statistics Request Control Log –FY202_
    3. SCD 58 forms
  5. pony to:

Office of the County Clerk-Recorder
70 W. Hedding 1st Fl

From: (Enter your office name and location.)

Orders are usually ponied out to the requester within 4–6 weeks.

Email Documents

To put documents together as PDF for emailing, you must have Adobe Acrobat Pro software. Follow the same procedures above for printing “SCD 58 Requests.”

Save “DEBS-In County Vital Statistics Request Control Log –FY2_” in PDF format by following these steps:

  • Select the filled out data.
  • "Save as Adobe PDF."
  • "Selection."
  • "Fit Worksheet to a single page.""Fit Worksheet to a single page."


  • Open "In County BIRTH Sworn Statement."
  • Right-click the page.
  • "Insert Pages."
  • "From File": Select previous saved PDF version of Vital Statistics Log.
  • Insert PDF versions of SCD 58 Request Forms in order according to the Log.

Note: To make it easier to insert SCD 58s in order, SAVE SCD 58 requests as “Worker No. and Client’s Last Name, First Name.”SAVE SCD 58 requests as “Worker No. and Client’s Last Name, First Name.”

save SCD 58

  • "Edit PDF."
  • "Add Text."
  • Number SCD 58 forms according to the Log and ensure the number of requests in the document match the number on the Log.
  • Save PDF as “(Office Name) – In County Birth Certificate Requests Order Date.”
  • Send the document via DocuSign to the Supervisor to completeSupervisor to complete.

    supervisor signature

Once signed, save the approved copy.

Submit the following documents via email to the County of Santa Clara Office of the County Clerk-Recorder and copy Accounts Payable:

  • Sworn Statement (signed via DocuSign)
  • Vital Statistics Log
  • “Application for Verification of Birth, Death or Marriage” (SCD 58)

County of Santa Clara Office of the County Clerk-Recorder and Accounts Payable email addresses:

Reminder: The email process described above is only compatible with Adobe Acrobat Pro software.

Computer-Generated Abstracts of Birth Records

The CDPH, Office of State Registrar of Vital Statistics, will routinely fill requests for birth information with a computer-generated abstract for those records of births in California since 1905, other than those in Santa Clara County.

  • Abstracts are considered more “fraud-proof.”
  • Rather than abstracts, “regular” certified birth certificates may be obtained by indicating on the request that they are desired. The EW must indicate “regular” when submitting verification request to clerk.
    • Regular certificates are required to determine Indian heritage.
    • There is no extra cost for regular certificates.
  • Requesting procedures remain unchanged.

Security Features

The certified copy of a birth abstract has the security features of bank note quality paper, including:

  • The fine-line lathe-work border design and state seal are printed by a deep intaglio (indented) steel-plate process.
  • The border contains latent image letters “V” and “R” which are visible when the form is held at a prescribed angle while looking toward a light source (can't be seen on photocopies).
  • The background color is a fine line prismatic tint difficult to reproduce in normal photo and Xerox processes.
  • The inks are fluorescent and erasure-sensitive, making any attempt to erase or alter them very evident.

Providing Copies of Abstract

Due to SB 247, it is a violation of state law to provide these copies to individual clients. Legislation went into effect July 1, 2003, requiring the County Recorder’s Office to issue two (2) different types of certified copies to requesters. In an attempt to make identity theft more difficult, SB 247 requires that persons requesting certified copies of birth and/or death certificates sign a statement under penalty of perjury that they are authorized to receive an authorized certified copy. Providing clients with these certificates circumvents this process. Government agencies receive these documents for their use only. If Social Services no longer has a need for these certificates once they are scanned into Imaging, they must be destroyed. By no means are these certificates to be given to the clients.

Children Under Six Months Old

In June 2006, the Office of Vital Records with the State of California ceased providing birth certificates for children under six months old. The basis for this is due to a decrease in staffing, and their inability to keep up with the increased workload. The State Department has modified their policy to update their database once newborns turn six months of age. Any requests sent to the State Department for newborns under six months of age will be returned indicating the request is “too recent.” In order for SSA clerical staff to avoid holding on to the request until the newborn turns six months of age, effective immediately, the “Application for Verification, Birth, Death or Marriage” (SCD 58) will no longer be sent to the State Department Office of Vital Records for children under six months of age born outside of Santa Clara County. Instead, the SCD 58 will be forwarded to the County Recorder’s Office or County Health Department in the county where the child is born.

Exception: If the child is born in Santa Clara County, the six month time limit does not apply since requests will be sent to Santa Clara's local County Public Health Department.

Reminder: When the request is out of county, clerical staff will forward the SCD 58 to Accounts Payable, 333 W. Julian St., 2nd Floor. Accounts Payable will request the birth certificate from the appropriate source.

Requesting Certificates within California

Processes for the State of California are different than other states. When requesting a birth or death certificate within the State of California (NOT for Santa Clara County), the following must occur:

  1. The EW:
    1. Completes a “Clerical Check Sheet” (SCD 109) indicating the certificate required.
    2. Submits the SCD 109 to clerical for processing.
  2. The Clerical:
    1. Receives SCD 109.
    2. Completes SCD 58 and emails to Lay-Poh.Ong at accounts.payable@ssa.sccgov.org at Accounts Payable.
  3. The Accounts Payable:
    1. Receives SCD 58s.
    2. Forwards request to California Department of Health, Office of State Registrar of Vital Statistics.

Requesting Certificates Outside of California

When requesting out of state certificates, in addition to the SCD 58, clerical staff must also complete a separate form located on the state’s website and submit that form along with the SCD 58 to Accounts Payable. Each state has their own form, and the forms may be located, as follows:

  • Clerical receives the SCD 109 from the EW requesting an out of state certificate.
  • Go to www.vitalrec.com.
  • Click States and Territories.
  • Click the state from which you are requesting the certificate.
  • Scroll down the page to “Order Birth And Death Records On-line.” Click “mail order” for the certificate you are requesting. Choices are: Birth, Death, Marriage, and Divorce.
  • Scroll down the page and click “Download Request For Certified Copy Of (Birth, Death, Marriage, Divorce) Record.”
  • Completes the SCD 58.
  • Complete the state form and attaches it to the SCD 58.
  • Submits both forms to Accounts Payable at accounts.payable@ssa.sccgov.org.

Photo IDs

Many states and the federal district now require that the requester's (EW's) photo ID accompany their state form. States that require a government-issued photo ID accompany the request are as follows:

District of Columbia (DC)

Iowa (IA)

New Jersey (NJ)

South Carolina (SC)

Alaska (AK)

Kansas (KS)

New Mexico (NM)

Tennessee (TN)

Arizona (AZ)

Louisiana (LA)

New York (NY)

Texas (TX)

Colorado (CO)

Maryland (MD)

North Carolina (NC)

Utah (UT)

Connecticut (CT)

Michigan (MI)

Oklahoma (OK)

Virginia (VA)

Florida (FL)

Nebraska (NE)

Oregon (OR)

Wyoming (WY)

Idaho (ID)

Nevada (NV)

Pennsylvania (PA)

Indiana (IN)

New Hampshire (NH)

Rhode Island (RI)

The EW must submit a copy of his/her badge when requesting verification from these states. A copy of the badge must be submitted with the SCD 109.

Note: Some states may require written permission from the client prior to obtaining the birth certificate (i.e., Pennsylvania).

Release of Information

In addition to the employee ID, the following states also require an “Authorization to Release Information” (SCD 1029) when requesting out-of-state birth certificates:

  • Connecticut,
  • Florida,
  • Indiana,
  • Louisiana, and
  • Maryland.

Notarization of Application

Minnesota and New York City require the application to be notarized, prior to accepting and processing the request. When a birth certificate is being requested from a state that requires the application to be notarized, the following must occur:

  • The website will indicate that the document must be notarized.
  • Clerical must complete the process as noted in Section 10.4 (and 10.4.1 and 10.4.2, as appropriate).
  • Clerical must make an appointment with Collections via email.
    • A courtesy copy must be sent to Janet Cancilla, Paul Tran and Kent Maruyama.
    • Once the appointment is scheduled, clerical must hand-carry the application to Recovery and Legal, which is located at 333 W. Julian St.
  • The application MUST be signed in the presence of the notary.
  • Once notarized, the application must be submitted to Accounts Payable, which is located next door to Recovery and Legal, as noted in Section 10.4.

Note: Idaho also requires the application be notarized; however, the application MUST be notarized by the head of household. The State of Idaho will NOT accept applications notarized by county employees.

Related Topics

Receipt of Verifications Requested by Clients