Form A3, the Free Birth Record Request Form and Status Certification, is the Cook County Clerk's Vital Records form for asking for a certified copy of a birth record at no cost. It is one of the ways to request a Cook County birth certificate, and it is meant for people born in Cook County who are verified as homeless, residents of domestic abuse shelters, recently released from custody, or about to be released. On this page you can fill out the form online on FillingPDF and download or print the completed PDF; the form itself is published by the Cook County Clerk at cookcountyclerkil.gov.
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What is A3?
Form A3, the Free Birth Record Request Form and Status Certification, is the Cook County Clerk's Vital Records form used to request a certified copy of a Cook County birth record at no cost when the requestor's status is verified by an agent or agency.
The form has two pages that work together. Page 1, the Birth Record Request Form, collects the name at birth, date of birth, place of birth (city or village in Cook County), the parents' names and the requestor's own details. Page 2, the Status Certification, is completed by a verifying agent or agency to affirm the individual's status when the certification is completed. The form states that both pages must be submitted to receive a birth certificate.
A certified copy is free for persons born in Cook County who are verified as one of the following:
- homeless;
- a resident of a shelter for victims of domestic abuse or violence;
- released within the last 90 days from Illinois Department of Corrections (IDOC) or Cook County Department of Corrections (CCDOC) custody;
- a current inmate or detainee who will be released within the next 90 days by IDOC or CCDOC.
The form cites Illinois law [410 ILCS 535/25 (4) (b)]: a certified copy of a birth record is available only to persons with a "direct and tangible interest" in it.
Who needs to file A3?
The main group is people born in Cook County who want a certified copy of their birth record at no cost and whose status has been verified in one of four categories: homeless, survivor of domestic abuse (resident of a shelter for victims of domestic abuse or violence), ex-offender released from IDOC or CCDOC custody within the last 90 days, or current detainee or inmate who will be released by IDOC or CCDOC within the next 90 days. The status certification also covers a person whose children are in one of these situations.
Under the Illinois law cited on the form, a certified copy is available only to someone with a "direct and tangible interest" in the record, such as the person named (if 18 years old), a parent, a guardian or a legal representative. The form has a space for the requestor's relationship to the child, if applicable.
Page 2 is completed by a verifying agent, not by the requestor. The form lists who may verify status:
- a homeless service agency receiving government funding or sanctioned by a local continuum of care;
- an attorney licensed in Illinois;
- a public school homeless liaison or school social worker;
- a State-funded human services provider for homeless or runaway youth, individuals with mental illness, or individuals with addictions;
- a staff member of a domestic violence shelter;
- a staff member of a human service agency or government office that assists the incarcerated or formerly incarcerated.
When to file A3
File Form A3 when you need a certified copy of a Cook County birth record and your status fits one of the free categories. The form prints no filing deadline. Timing matters in two ways: the Status Certification must be received by the Cook County Clerk's office at the time of application, and the custody categories are time-limited. A person released from IDOC or CCDOC custody qualifies within 90 days of release, and a current inmate or detainee qualifies when release is expected within the next 90 days. The verifying agent dates the certification on page 2, so arrange it before you send or bring the request.
Documents you need
- The completed Status Certification (page 2), filled out and signed by a verifying agent or agency; the form says it must be submitted with the request.
- A photocopy of your photo identification, such as a driver's license or state-issued identification, when you request the record by mail.
- A self-addressed stamped envelope, when you request the record by mail.
How to fill out A3
Select your status category
On page 1, select one: Homeless, Survivor of Domestic Abuse, Ex-offender or Current detainee/inmate. This must match the status the verifying agent certifies on page 2.
Enter the name at birth
Under Birth Record Information, write the First Name, Middle Name and Last Name as they appear at birth.
Enter date and place of birth
Enter the date of birth as Month/Day/Year and the place of birth as the city or village in Cook County.
Enter the parents' names
For Parent 1, enter the first name and last name (maiden name); if the person was adopted, enter the mother's name at the time of adoption. Parent 2 is optional.
Complete the requestor information
Print your name, sign, and enter your telephone number and mailing address (street address, city, state, ZIP). Enter your relationship to the child if applicable.
Have the verifying agent start page 2
On the Status Certification, the agent enters the date as Month/Day/Year, names the person and selects the current status, then selects the basis on which the agent is qualified to verify it.
Add the agency details
The agent enters the agency or organization name and telephone number, its mailing address, and the Agency Federal Tax ID Number or Attorney Registration Number.
Have the agent sign the certification
The agent prints their name and signs and dates the statement made under penalty of perjury that they represent the agency and the applicant resides at or receives services from it.
Review, download and assemble
Check that both pages are complete and consistent. Download or print the completed PDF from FillingPDF, add the items described under How to submit, and send it through the Clerk's channels.
How to submit A3
There are two ways to obtain the birth record: by mail or in person at the Cook County Clerk's Office. Both pages of the form must be submitted.
- By mail: Fill out the form and mail it to Bureau of Vital Records, P.O. Box A3390, Chicago, IL 60690. Include a photocopy of your photo identification (for example a driver's license or state-issued identification) and a self-addressed stamped envelope.
- In person: Visit the Cook County Clerk's Office at 118 N. Clark St., Room 120, Chicago, or one of the three suburban offices. Call (312) 603-7790 or go to cookcountyclerk.com/vitals for locations and hours.
The completed Status Certification (page 2) must be received by the Clerk's office at the time of application. The Vital Records office lists tel 312.603.7788 and fax 312.603.4899. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Submitting only page 1; the form states that both pages must be submitted to receive a birth certificate.
- Leaving the Status Certification to be sent later; it must be received by the Clerk's office at the time of application.
- Mailing the request without a photocopy of your photo ID or without a self-addressed stamped envelope.
- Having someone other than a listed agent or agency verify status, or leaving the agent's Federal Tax ID or Attorney Registration Number blank.
- Selecting a status that does not match the certification, or one that is outside the 90-day windows for release from IDOC or CCDOC custody.
- Requesting a record of a person you have no "direct and tangible interest" in; the form says only such persons can obtain a certified copy.
- Entering a place of birth outside Cook County; the form asks for the city or village in Cook County.
- Using the form to deceive: using or attempting to use a certificate for deception is a Class 4 felony under the cited Illinois law.
Frequently asked questions
How do I get a free Cook County birth certificate?
Complete Form A3 with the Status Certification verified by an eligible agent or agency, then mail it to the Bureau of Vital Records or bring it to the Cook County Clerk's Office. The copy is free for people born in Cook County who are verified as homeless, in a domestic abuse shelter, recently released from custody or about to be released.
Who qualifies for a free birth certificate on Form A3?
Persons born in Cook County verified as homeless, residents of shelters for victims of domestic abuse or violence, released within the last 90 days from IDOC or CCDOC custody, or current inmates or detainees to be released within the next 90 days.
Who can complete the Status Certification on page 2?
A verifying agent or agency listed on the form, such as a homeless service agency, an Illinois-licensed attorney, a school homeless liaison or social worker, a domestic violence shelter staff member, or staff of an agency assisting the incarcerated or formerly incarcerated.
Can anyone request a certified birth record with Form A3?
No. The form cites Illinois law limiting certified copies to persons with a "direct and tangible interest", such as yourself (if 18 years old), a parent, a guardian or a legal representative.
Do I have to submit both pages of Form A3?
Yes. Both pages must be submitted to receive a birth certificate. Page 2, the Status Certification, must be received by the Cook County Clerk's office at the time of application.
Where do I mail Form A3?
Mail it to Bureau of Vital Records, P.O. Box A3390, Chicago, IL 60690. Include a photocopy of your photo ID and a self-addressed stamped envelope. You can also apply in person at 118 N. Clark St., Room 120, Chicago.
Can I fill out Form A3 online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is an independent service and does not submit the request to the Cook County Clerk; you mail it or bring it in person.
What happens if someone uses a birth certificate to deceive?
The form warns that anyone who willfully and knowingly uses or attempts to use a certificate or certification for deception is guilty of a Class 4 felony under 410 ILCS 535/27 (c), (f), punishable up to three years in prison.
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