Certificate of Birth Foundling

When a newborn is born outside of a hospital facility and relinquished into the Safe Haven
Program, a Certificate of Birth, known as a Foundling Certificate, must be completed.
Under the New York Department of Public Health and Social Services Law, this certificate
shall constitute the birth record of the newborn. The district (county) where the newborn
was relinquished shall be considered the place of birth. The pediatrician on call, after
examining the newborn, will determine an approximate date of birth, sex and race of the
newborn to be entered on the Founding Certificate. The form will then be sent to the public
welfare officer, who under the law shall make the final determination of the childs date of
birth. For further explanation of the form, refer to section 398 under the Social Service Law
and Section 4131 and Section 4170 under Public Health Law. Here are excerpts:
Extract From Social Services Law
398. Additional powers and duties of the commissioners of public welfare and certain city public
welfare officers in relation to children. Commissioner of public welfare and city public welfare
officers responsible under the provisions of a specific or local law for children hereinafter specified
shall have powers and perform duties as follows:
1. ****
2. As to neglected or abandoned children:
(a) ****
(b) ****
(c) Report to local registrar of vital statistics of the district in which the child was found, the
sex, color, approximate date of birth, place of finding, and the name assigned to any child
who may be found whose parents are unknown, within ten day whenever possible after the
child is found, on form prescribed therefore by the state commissioner of health: provided,
however that in the City of New York such shall be prescribed by, and such report shall be
made to the city commissioner of health.
Extract From Public Health Law
4131. Birth; registration; foundlings
1. The report of the finding of a child whose parents are unknown, filed by the commissioner of
welfare or by the city public welfare office in accordance with the provisions of subdivision
two of section three hundred ninety-eight of social welfare law, shall constitute the birth record
of such child.
2. The district wherein such child was found shall be considered as the place of birth, and the date
of birth shall be that determined by the commissioner of public welfare or by the city public
welfare officer as the approximate date of birth.
3. If, however such child be subsequently identified, and it should appear that a certificate of birth
for this child has either before or following identification been filed, as otherwise provided in
this article, the report of the commissioner of public welfare or the city public welfare shall be
placed under seal by the state commissioner of health, such seal not to be broken except upon
order of a court of competent jurisdiction.
4170. Records; general duties of registrars.
Each registrar shall at such times as the commissioner shall direct, and as otherwise ordered by the
commissioner as provided in section four thousand seventy-two of this chapter transmit to the
commissioner all original certificates, including reports of foundlings, as required by section three
hundred ninety-eight of the social services law, and orders relating to parentage registered by him.

NEW YORK STATE DEPARTMENT OF HEALTH

Vital Records Section

Certificate of Birth Foundling

Write legibly with durable black ink. This is a permanent record.

Dist. No. _________(to be inserted by registrar)

Registered No. _________

1. PLACE OF BIRTH; STATE OF NEW YORK

a. County _____________ b. Town ________________ c. City or Village______________

2. FULL NAME OF CHILD __________________________________________________

FIRST

MIDDLE

LAST

3. Sex_______4. Race ________________ 5. Date of Birth ______/_______/_______

MONTH

DAY

YEAR

This birth certificate of a child found on ___________________________________ 20____

At _______________________________________, State of New York, is made by me as
Commissioner of Social Services of ________________________________________________
in accordance with the provisions of Section 398 of the Social Services Law.

Signed_________________________________________
COMMISSIONER OF SOCIAL SERVICES

Date____________ 20______

Address_______________________________________
________________________________________
_________________________________________

Field ____________ 20_____

____________________________________
REGISTRARS SIGNATURE