NATIONAL CENTER Series 4 

For HEALTH STATISTICS Number 8 

VITAL and HEALTH STATISTICS 

DOCUMENTS AND COMMITTEE REPORTS 

P??oPEmOFTHE 

fLJBLICAT/o~s f)~~~ 

EDITORIALLIBMRV 

The1968Revisionof the 

StandardCertificates 

Discusses the procedure followed in the 1968 revision of the Standard Certificates of Live Birth, Death, Fetal Death, Marriage and 

Divorce or Annulment; the history and basic principles of the Standard Certificates and the maior objectives of this revision are outlined; the principal additions, modifications, and deletions of items 

are described; design and printing of the certificate forms are also 

considered. 

June 1968 Washington, D.C. 

U.S. DEPARTMENT OF 

Public Health Service HEALTH, EDUCATION, AND WELFARE 

Wil Iiam H. Stewart Wilbur J. Cohen 

Acting Secretary Surgeon General 
Public Health Service Publication No. i 000-Series 4-No. S 

— 

For Me by the Superintendent of Documents, U.S. Government Printing ~~IW 

Washington, D. C., 20402- Price 40 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

THEODORE D. WOOLSEY, Director 

PHILIP S. LAWRENCE, SC.D., Associate Director 

OSWALD K. SAGEN, PH.D.,, Assistant Director /or Health Statistics Development 

WALT R. SIMMONS, M. A., Assistant Director /or Research and Scientific Development 

ALICE M. WATERHOUSE, M. D., Medical Consultant


JAMES E. KELLY, D. D. S., Dental Advisor


LOUIS R. STOLCIS, M. A., Executive O//icer


DIVISION OF VITAL STATISTICS 

ROBERT D. GROVE, Ph. D., Director


ROBERT A. ISRAEL, M.S., Deputy Director


ARTHUR A. CAMPBELL, special Assistant to the Director


ROBERT A. ISRAEL, M.S., Acting Chief, Mortality Statistics Branch


ARTHUR A. CAMPBELL, Acting Cbie/, Natality Statistics Branch


ROBERT D. GROVE, Ph. D., Acting Chic/, Registration Methods Branch


PATIENCE LAURIAT, M.A., Cbie/, Marriage and Divorce Statistics Branck


ARNE B. NELSON, M.A., Cbie/, Vital Records Survey Branch


ALICE M. HETZEL, Chief, Statistical Resources Section


Public Health Service Publication No. 1000-Series 4-No. 8 

Library of Congress Catalog Card Number 68-60060 
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CONTENTS 

Importance 

History 

Principles 

Major Objectives 

Method 

Principal Issues and Additions 

Other Additions or Modifications 

Live Birth and FetalDeathCertificates


Death Certificate


Marriage Certificate


Divorce Certificate


Additions Considered, But Not Adopted 

Live Birth and Fetal Death Certificates 

Death Certificate 

Marriage Certificate 

Divorce Certificate 

Deletions 

Design and Printing 

Implementation 

Detailed Tables 

Page 

1


1


2


3


3


5


9


9


9


9


10


10


10


11


12


12


13


13


14


17


. .. Ill 
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IN THIS REPORT the most vecent (1968) vevision of the Standard Certificates of Live Birth, Death, Fetal Death, Mavriage, and Divorce OY 

Annulment is discussed. The impovtunce of these starukwd certificates 

to natio?ud vital statistics, theiv historical development, and the basic 

principles underlying them art? considered. The majov objectives of the 

1968 revision aye stated. The process of obtaining comments and opinions of many persons and organizations through questionnaires, committee discussions, and national meetings is descvibed in detail. The 

principal changes made in the latest stundard certificates and the major 

issues and di~evences of opinion are explained. 

SYMBOLS I 

Data not available 

Category not applicable . . . 

I Quantity zero - I 

I Quantity more than O but less than 0.05 ----- 0.0 I 

Figure does not meet standards of 

reliability or precision *

1 J 
THE 1968 REVISION OF THE 

STANDARD CERTIFICATES 

Robert D. Grove, Ph. D., Division of Vihl Statistics 

IMPORTANCE 

The vital statistics of the United States are 

collected and published by a decentralized, cooperative system in which control of the registration 

of live births, fetal deaths, deaths, marriages, 

divorces, and annulments is vested in the individual States and certain independent registration 

cities. The degree of uniformity necessary for 

national statistics has been obtained by a periodic 

issuance of recommended standards from the 

responsible national agency, and their cooperative 

adoption by the individual States. The standard 

certificates have been the principal means for 

achieving uniformity in the information upon which 

national vital statistics are based. Prior to 1946 

the Bureau of the Census issued the nationally 

recommended standard certificates. Since that 

year, the Public Health Service has performed 

this function. It has also been customary for representatives of the State Vital Statistics Offices 

to advise and assist the responsible national 

agent y in the development of the standard certificates. 

HISTORY 

Adoption of a law patterned after the Model 

State Vital Statistics Law was one of the original 

requirements for the admission of a State into 

the National Birth and Death Registration Areas, 

which were established to promote national vital 

statistics. Early editions of the Model Law included a provision stating that the State’s certificates must contain as a minimum the items on the 

standard certificates. The latest (1959) edition 

of the model law contains a similar provision 

but it allows for modification by the State health 

department. 

Including the latest (1968) revision, there 

have been nine editions of the Standard Certificates of Live Birth and Death, five editions of 

the Standard Certificate of Fetal Death (formerly 

Stillbirth) and two editions of the Standard Certificates or Records of Marriage and Divorce or 

Annulment (tables 1-5). 

It is instructive to compare the successive 

versions of the Standard Certificates of Live 

Birth and Death. The time interval between the 

first and latest revisions is 68 years for both 

the birth and the death certificates. Of the 34 

items on the first Standard Birth Certificate 

(1900), 27 are continued in the 1968 revision. 

There are 21 items on the 1968 certificates not 

included in the 1900 version. The additions are 

concerned with more detailed information about 

children previously born to the mother, period 

of gestation, birth weight, prenatal care, medical 

aspects of the pregnancy and delivery, medical 

condition of the infant, and a more detailed specification of place of mother’s residence. 

The first (1900) version of the Standard Death 

Certificate contained 42 items, of which 33 are 

continued in the latest (1968) revision and there 

are 30 items on the 1968 certificate which were 

not included in 1900. The additions are chiefly 

concerned with more detailed information on 

causes of death, miscellaneous items such as 

1

citizenship, marital status, and Social Security 

number, and an entire section is devoted to deaths 

from external causes. The most interesting item 

deleted in the recent revisions was a question on 

place of contraction of the disease causing death. 

PRINCIPLES 

Vital records are used for so many different 

purposes that many factors must be considered 

and evaluated in deciding what should be recommended as the national standards. 

1. 

2. 

3. 

The records must serve legal and personal identification purposes. These require information on names, age, date 

and place of occurrence, signatures, and 

addresses. The individual and numerous 

public agencies— schools, welfare departments, Passport Office, Social Security 

Administration, and Veterans Administration—have a direct interest. 

They must provide the statistical information needed by State and local government agencies, particularly health departments, to plan and evaluate their 

programs. The specific data needed vary 

considerably, due to the large differences 

between States in size and composition of 

population, local government organization and magnitude of public programs. 

The needs for vital statistics for the entire 

country are numerous, varied, and in 

many cases related to major public programs. Statistics of births, deaths, marriages, or divorces are frequently used 

in public health research and administration to measure and analyze rates of 

population growth and changes in population composition, to study social problems, e.g., broken families and illegitimacyy, and to measure actuaI or potential 

consumers for numerous products and 

services. 

Faced with these many and varied uses of 

vital records, the national vital statistics agency 

and each State vital statistics office must make 

choices for inclusion and exclusion, and the 

choices are sometimes difficult to make. The 

choices must take into account certain limitations 

and certain advantages inherent in the registration process. 

Compared with a census or with most special 

household surveys, the amount of information 

that can be reasonably asked in a registration 

form is quite restricted. It is limited by the fact 

that the form is a legal as well as a statistical 

record and will be retained permanently for personal identification purposes. The legal nature 

of the record limits its use for statistical or 

scientific purposes by competition for available 

space on the form and by respondents’ reluctance 

to provide certain kinds of information on a form 

known to be used for identification purposes. To 

some extent this problem has been alleviated by 

dividing the birth record into two sections, with 

the bottom section containing information used 

only for scientific purposes and detached or not 

used for legal purposes, but this problem is still 

far from being solved. 

The amount of obtainable information is alsc 

restricted by the number of vital records that 

must be completed and processed each yearapproximately 4,000,000 births, 1,900,000 deaths. 

1,700,000 marriages, and 400,000 divorces —ant 

by the number and variety of persons responsible 

for completing them, i.e., several hundred thousand physicians ,funeral directors, hospital clerks, 

coroners, ministers, and local officials. C)bviously, these conditions are quite different from 

those in which information is sought for a relatively small sample of cases or even for tht 

entire population by trained enumerators or interviewers. The physical dimensions of vital records, 

the time devoted to completing each record, and 

the variability of the training, competence, and 

interest of the persons completing the record 

all impose severe restrictions. 

Within the limitations inherent in the purpose:: 

and nature of the registration system, the Statt: 

and national vital statistics offices must selec: 

for inclusion on the records those items which 

meet certain criteria: 

1. The information is needed for personal 

identification or for establishing timt 

and place of the event, or 

2 
2. 

3, 

The information has a high priority among 

the data needed for scien~ific or public 

program purposes, and 

There is a basis for believing that it can 

be obtained with adequate completeness 

and accuracy with reasonable efforts. 

MAJOR OBJECTIVES 

Early in the 1968 revision process, four 

ajor objectives were formulated: 

1, 

2, 

3. 

4, 

To serve expanded research interests 

and new program needs without overburdening the registration system or compromising the legal uses of the records. 

To provide increased protection of confidential-type or potentially discriminatory 

information and thus to encourage its 

accurate reporting and continued availability for important scientific and program 

purposes. 

To consider and reflect in the certificate 

forms, to the extent appropriate, the potential impact of technological advances in 

records management and data transmis ­

sion and processing. 

To develop a certificate format which 

would encourage reporting of more complete and accurate information. 

METHOD 

The most recent thorough revision of the 

Standard Live Birth and Death Certificates was 

in 1949. The 1956 revision was deliberately 

limited to minor changes because only 6 instead 

of the usual 10 years had elapsed since the previous revision, The principal reason for the 1956 

revision was to change the timing of revisions 

from census-period years to mid-decade years. 

Under these circumstances, it seemed that in the 

next revision all of the certificates should be 

thoroughly reexamined with respect to both content 

and format. 

It was determined that a potentially major 

revision required broad solicitation of views 

among Federal and State official agencies; national 

and State medical, hospital, mortuary, and other 

associations concerned with producing vital rec -

orals; and the associations and individuals concerned with uses of vital statistics in the areas 

of health, medicine, demography, social problems, 

insurance, and economics. It was also clearly 

desirable to enlist the help of advisory groups 

which included members actively engaged in one 

or more aspects of the production and use of 

vital records and statistics. 

Realistic pretests of certain items and groups 

of items were originally planned; but they proved 

too difficult to arrange. Preliminary arrangements were worked out with one registration 

area to test different ways of asking the medical 

questions on the live birth certificate. The idea 

was to have certain hospitals use two kinds of 

forms and compare them for completeness of 

information. However, it was decided that the 

test could not be made because of the extra work 

involved for the hospitals. 

It is definitely more difficult to pretest an 

official form, such as a vital record, than a 

survey or census schedule. The form to be tested 

must be used in addition to the form then in effect. 

This imposes extra and unwelcome work for the 

hospital, physician, funeral director, and others. 

Also, it is hard to conduct the test in a way that 

closely corresponds to normal registration procedures and does not introduce artificial conditions. The first obstacle might be overcome by 

paying adequately for the additional work performed, but the problem of providing realistic 

test conditions deserves some basic thinking and 

experimentation. 

One of the workshops conducted during the 

National Meeting of the Public Health Conference 

on Records and Statistics (PHCRS) in June 1962 

was devoted to advance planning for the revision 

of the standard certificates. The primary purposes 

and results of this workshop were to evaluate 

experiences with the current standard certificates, to obtain suggestions for changes in the 

certificates, and to formulate procedures to be 

followed in the impending revision process. 

Early in 1963, three study groups of the 

Public Health Conference on Records and Statistics were formed to advise and assist the National 

Center for Health Statistics. They were assigned 

to work respectively on (1) content of the certifi3 
cates, (2) format, and (3) medicolegal aspects of 

death registration. Each of these groups held 

several meetings. The first major task was to 

obtain the opinions of informed persons and interested agencies and organizations on desirable 

changes. Detailed questionnaires covering numerous possible additions, deletions, or changes in 

the contents of the five standard certificates were 

developed. The second part of the questionnaires 

was used to obtain opinions on the desirability 

of sectionalizing the certificates to differentiate 

information that should be routinely, occasionally, 

or never included in public copies. These questionnaires were mailed in August 1963 to 1,145 persons 

or organizations. Although a majority received all 

questionnaires, some persons received only those 

for birth and death, or marriage and divorce, 

or only the death certificate. Approximately 300 

birth and death questionnaires and about 170 

marriage and divorce questionnaires were returned. 

This information was tabulated and discussed 

at meetings of the three study groups in December 

1963 (tables 6-13) and first drafts of the new certificates were reviewed by the study groups in 

March 1964. Revised drafts were then prepared 

and sent, with an explanation and a summary of 

the questionnaire results, to all State vital statistics officials and other persons invited to 

attend the national meeting of the Public Health 

Conference on Records and Statistics in June 1964. 

At that meeting one and one-half days were 

devoted to workshops in which the drafts of the 

new certificates were discussed. Approximately 

200 persons attended these workshop discussions, 

and sharp differences of opinions on some ques ­

tions were evident both in the discussions and in 

the answers to the mail questionnaire. These 

opinions were carefully reviewed in the National 

Center for Health Statistics and in February 1965 

revised drafts of the certificates were prepared 

and discussed with the new study group of the 

Public Health Conference on Records and Statistics. This group included representatives from 

each of the three earlier groups plus several new 

members. 

Following this meeting, new certificate drafts 

were prepared and mailed with a second questionnaire to 260 persons or agencies, selected on the 

basis of their demonstrated interest in vital statistics or their close relationship to the registration process. Replies were received from over 

40 percent of the addressees. The results were 

summarized and discussed at a meeting of the 

study group in late July 1965 (tables 14-18). 

Summaries of the questionnaire responses 

and of the study group meeting were sent to the 

American Association for Vital Records and 

Public He&h Statistics for discussion at its 

national meeting, August 9-10. Five recommendations relating to the standard certificates 

were made at this meeting and communicated to 

the National Center for Health Statistics. They 

were: 

1.	 Delete mother’s date of birth on the Standard Live Birth Certificate. 

2.	 Delete age of surviving spouse on the 

Standard Death Certificate. 

3.	 Exclude confidential sections in the Standard Certificates of Marriage and Divorce. 

4.	 Define the term “institution” on the Standard Death Certificates from January 1, 

1967 to January 1, 1968. 

5.	 Change the effective date of the new 

standard certificates from January 1, l%j7 

to January 1, 1968. 

All of these recommendations, except the one 

dealing with inclusion of confidential sections on 

the marriage and divorce certificates, were 

followed by the NCHS. 

During the revision process, communication 

was also maintained with other committees or 

groups interested in the standard certificates. 

They were: 

1. Committee on Standard Certificates and 

the Council of the Statistics Section, 

American Public Health Association. 

2.	 Committee on Standard Certificate Revision, American Association for Vital 

Records and Public Health Statistics. 

3.	 Committee on Population Statistics and 

Subcommittees on Natality and Mortality 

Statistics, Population Association of 

America. 

4 
4. 

5. 

6. 

In 

United States National Committee on Vital 

and Health Statistics. 

Committee on Marriage and Divorce Statistics, American Sociological Association. 

Panel of advisors of the National Center 

for Health Statistics. 

March 1966, revised drafts of the certificates were distributed to all State offices which 

reflected the discussions of the PHCRS Study 

Group Meeting in July 1965, the recommendations 

of the AAVRPHS at its meeting in August 1965, 

and further consideration by the staff of the National Center for Health Statistics. 

The standard certificates were again the 

subject of discussion in workshops held during 

the biennial National Meeting of the Public Health 

Conference on Records and Statistics in June 1966. 

However, the emphasis was shifted to the problems 

of implementing the new certificates. Opportunity 

was given for suggesting changes with the understanding that they should be limited to editorial 

and style matters. For this workshop review, the 

March 1966 varityped drafts were redone by 

letterpress printing which gave a more accurate 

indication of the appearance of the new certificate 

forms. 

PRINCIPAL ISSUES AND ADDITIONS 

Inclusion and location of item requesting 

information on Itrace, I?—During recent years 

there has been much discussion of the inclusion 

of this question on vital records and other forms. 

Four States (California, New Jersey, New York, 

and Ohio) have by legislative action removed this 

item from their marriage certificates. Legislation 

to remove the question from all vital records 

has been introduced, but not passed in several 

States. Several registration areas have changed 

the location of this question from the top parts 

to the back or bottom sections of the live birth 

and fetal death certificates. 

Several national associations have passed 

formal resolutions favoring continued collection 

of data on race, i.e., American Public Health 

Association, Association of State and Territorial 

Health Officers, American Sociological Association, Population Association of America, Social 

Statistics Section of the American Statistical 

Association, and the National Urban League. All 

of these resolutions emphasized the value of data 

classified by race in scientific research and in 

planning and evaluating public health and social 

welfare programs. They also stated that race 

information should not be used to identify individuals in a discriminatory way. A majority of 

respondents to the questionnaires also favored 

this view. In contrast, some Federal and State 

officials believe that “race” is still an important 

identifying characteristic and should be generally 

available from public records. 

The United States Supreme Court has affirmed 

a lower Federal Court ruling which upheld the 

legal right of a State to ask for information on 

race where the purpose is not to use it for discriminatory purposes. 

Considering the above facts the NCHS decided 

that to retain this information for social and 

scientific purposes and to discourage its use for 

personal and discriminatory identification, the 

question should be located in the bottom, confidential sections of the Standard Certificates of 

Live Birth, Fetal Death, Marriage, and Divorce 

or Annulment. 

Substitution of item on education foy items 

on occupation and indwtvy, — Several considerations led to the substitution of education (highest 

grade of regular school completed) for occupation 

and industry, as an indicator of socioeconomic 

status. Occupation of the father had been included 

on the Standard Certificate of Live Birth since 

1900 and industry since 1918. Although these items 

have been used in studies of mortality where serious limitations of the data were apparent, they did 

not prove useful in other vital statistics studies. 

The chief weaknesses were inaccurate or nonspecific reporting, a lack of comparability with information for the same people in the population 

census, and the high costs of classifying the records. There seems to be good evidence that a 

question on education will suffer less from these 

deficiencies. 

Generally, an individual’s educational attainment does not change after he reaches maturity and the categories used to describe education commonly understood. Responses have been 

obtained with little difficulty in the population 

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census and on the birth certificate in Puerto Rico it was a live birth or fetal death. However, a 

which added the item in 1963. The information is question on date of first marriage was strongly 

easier to code and should be more comparable opposed by State vital statistics officials for 

between vital and census records. However, there several reasons. It might be illegal in State~ 

was some opposition to including a question on which by law forbid any question on legitimacy. 

education on the grounds that itwould embarrass Also, it would be resented in cases of premarital 

some people and therefore, would not be answered pregnancy and cases involving more than onc 

or answered incorrectly. marriage, therefore, this question has been omitBoth occupation and industry have been re- ted. 

tained on the death certificate, because this infer- Questions on the date of last live birth or 

mation is used to study specific occupational fetal death were more favorably viewed, although 

diseases or accident risks. some vital statistics officials opposed them. Both 

Information on ch!ld sfiacing.-one of the demographers and public health scientists reconspicuous gaps in knowledge of fertility changes sponded favorably. The former will welcome data 

in the United States has been absence of regular on average spacing between successive births ir 

data on intervals between marriage and birth of analyses of fertility trends and the latter will bt 

first children and intervals between first and interested in relationships between child spacing; 

second, second and third, and all other children. and maternal and infant health. 

An earlier draft of the birth certificate contained Additional medical information on live bivt]t 

questions on date of first marriage, date of ter- and fetal death cevtificates(figs. 1 and 2).—Prior 

mination of last previous pregnancy, and whether to 1968, of the 56 independent registration area$ I 

6 
””, 

� 

(including the 50 States), 48 asked a question on 

congenital malformations, 32 had a question on 

complications of pregnant y, 13 included a question 

on prenatal care, and 34 included an item on birth 

injuries. Although this information was not included on previous standard certificates, an 

optional supplement has been recommended beginning with the 1939 revision. There seem to be 

cogent reasons for putting a greater national 

emphasis on this information at this time. 

The last 10 years have seen a definite leveling 

of the infant mortality rate. Federal and State 

programs have been started to achieve a significant reduction in the coming decade. More comprehensive data on these medical aspects of the 

birth process may assist in the identification 

of factors related to fetal and infant mortality. 

It is recognized that there is a serious 

problem of underreporting of this type of information. This is substantiated by several studies 

in which the birth certificates were compared 

with hospital records. There are also differences 

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of opinion concerning the relative merits of openend and checklist types of questions. Only one 

area now uses a checklist to obtain information on 

congenital malformations, and only one-third of 

the areas that obtain information on complications 

and birth injuries use checklists. 

The National Center for Health Statistics has 

decided to recommend open-end questions on all 

of the medical items to be located in the confidential sections of the certificates. They require 

much less space and can be accommodated within 

the dimensions of the present certificates. 

Fomat of death certificate. —No major 

changes of content are proposed for the Standard 

Certificate of Death. However, two alternative 

formats are proposed. Each of them provides 

clear differentiations between the deaths certified 

by medical examiners or coroners and those 

certified by other physicians (figs 3-5). 

Under the first alternative, all persons in a 

State would use one death certificate form to 

complete the medical certification. Separate 

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g MOTHER-MAIDEN NAMf ,,,,, .!,,,, 

3 

u


~
 RESIDENCE—STAW COUNTY

q 

; 

I 

: 

v PART I mAL DEATH WAS CAUSED BY 

j !,!., ., . .. .. . . ,-m,~,l C.”sc


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,,, IF NOT SINGLE IXUVERY ,0,. ,,”,,, ,,<..., ~~”~~y ~~ ~~~,”~~y 

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HOSPITAL— NbMF ,,, .0, ,. .0,,,,.,, .,., ,,, [” . . . “..,6., 

n 

M,,	 AGE IA, tl.E Ot %1S .,. Sr).,f OF BIRTH rlr NO! r. “,s..., . . . . ,0”.,,”, 

,.,.”, 

CllY, TOWN, OR LOCATl&	 ,Ns.E am ,,?.!,,s ;TREET AND NUMBER 

,Smc,w ,,, 0, . . . 

,1, .0, ,. U.S.A.. NM, m“”,,”, 

,,”,,”, 

85 8, 

[ENTER ONLY ONE CAUSF PER LINE FOR (.), (b), AND (c)J ,,ym~.1 0, 

~::::%.H~: i (0)
 :


fi ,,,., ..,,., w, ‘UE


,“, ,“.,.,.,, ..”,, g ,, ,!..,.., ,., i. 

“Cu.!”. CA.,, ,.,, 

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(c) : 

‘a”H’T( ,,s! ,.,’ ; (b) z ::~, .$.,.. 

PAkl II OTHER SIGNIFICANT 

~; ,,,, ”,,.0 ,. ,,,., ,,.,” ,., NO, 

g: 

-. , ,,,,,!” r“., ,“!, 0,,,”[,, .,,,, ~ 

,>, S,GNAIURf >s 

CERIIFIER—MA1llNG ADDEESS 

. 

174 

g“ ‘wnlAL. CREMATION, OR REMOVAL 

1“, ‘n ‘$ A cONs EOu FNcg ‘F


10, ‘* ‘$ A cONsEOUEW,E or 

CONOIT,,3NS OF FETUS OR MOTHER ,0..,,,..s ,.. ,[,”s ,,[, ,*’O”C U,o”, WN”6 UIO1 0“ AUTOPSY IF YES, w“, ,,..,.., CO.S,D. “,,.,,0 ,0 cm,,, 0,”!. 1. PA”, ,,., 0,(,”,,,, “,,,0., , s,,,,,, , ,,,, (,’, ,,, m ,,, ,,,, ,“ .CKU”, N,N. CA”,, 0, ~ 

10 I!, 

”,. ON ,., ..,, s,,,,, .,.,[ ,., ,“, ,,,”, v,., ,.,. ,,,. ~ATE ~,GNED ,MON,H, .,,, “m,, ATTENDANT-..U .00. .\twl% or”,. 

Mb ,*, G,P,aFf, 

(s,”,0 ., , , . . .0, cm c., ,OWN, s,,,,, z,,, ,,, 0,,,”,,, NO, .“,wm ,“ ?“,$,,,.., 

)3 SIGNATURE 

CEhfETERY on CREMATORY- NAMF LOCAT,ON ,,,”., m.., ,,.,,, 

,,b ,4. 

FUNERAL HOME —NAME AND ADDRESS (Srutr m “.,.0 NO,, cm 0, ,.W., ,,.,,. n,, 

15, 

REGISIRAR-S!GNAHJRE OA1[ RKEi!lD II ~\\iL t[:\\\MK 

,,,,,,,,, 

j ,’, 

DATE $.0.1”, 0.,, w.”, 

H 

14, 

FuNERAl iIRECTOR—SKNATURE 

~ 

\15b 

b 

s 

z v,.,,,, N,.,*, ..,,,,.. ,.,,,., ,,, 

~ 

,, 

i 

w“,!,, .,.”., ..,,!,,. ,“,,,., ,,, $ 

16. 

CONFIDENTtAL INFORtAATION 

EDUCA,,ON-SPFCI,” HIGHEST (3RADE 

6,!.,.,.,” “m. s,”.., 

, ,,,.,.,,,, 0, , , , ,,,,,, 0, 4 , 

EDUCATION — WE< IF? HIGHEST GRADE 

, , pM#m, .,.. ,,”00, 

,,011, ! ,,,,,, 0, 4 I 

.0”,” 

1n 

FOR MEDICAL AND HEALTH USE ONLY 

CCJMP,E,W PREV1OUS DELIVERIES —HOW MAN’( OTHER CH,LCIREN 

,“,,,., AM MOW ,,”,.6 WE”, ,0”. At,”E—Now y: ,,I:DR:,,:W:,; ;,$: 

r ,.,.,.,, ,, $+ , own y!.. , 

,,, Mb 

CO+! F,EIFD DATE CF LAST FFTAL DEATH 

,0,,,., *.IH .,, ,,., .0”,” m, ,,., 

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120 In 

, 0,,,” ,., ”,(, s ,0 ,,,”s ( ,1$,”,,, 0“ w“,,! ,.0.,, , 

28 

cON.EM17At mALF08Aur10Ns O* ANOMALIES o, w., , ,,s,,,,, ., ~,,,, . . . . . .. . 

30 

21 

= r., m SW, W, 

. ...,, ,., ..,,,,, 

% COM,KAT, ON$ mu,,. ,0 W.ECWANC, , mm”,,, .“ w,,,, ,,.O., -

LIVE BIRTH(SI 11 , 7 

COIAP,,CA,,*NS .0, RELATED,0 PReotm.c, , ,!s,”,,, m w“,,, ,,.0”,,., 2 

. 

tlTA, DEA1”,5, ?f 

<01APL,c&1,014s of UIOR ( ,,,,,,,, 0, w“,,, .. . . . . . , 

31 G,. ,,,, 0,-,4,.,’2 

Figure 2. Un ited States Standard Cart if icate of Fetal Death,

--

m.. 0,,. ”,. (P”, sic,,. ME., CAL ..,,.,,.,. !3, CORONER) ,! , ,0”,,..,., .,,”,, ”..,,,,, ,,,, O,–,,, -’5, 

W.m, ,“,,.. .0 ,,-,,,., 

T -us.STANDARD r 

TYPE, OR PRINT IN mm, n,, .“.,,, CERTIFICATE OF DEATH ‘ ,!.,! n. ““.,,, 

‘~lM&~u&\&K DECEASED—NAAW ,,,$, .,..,, mm .5Ex DATE OF OEATH r.o.w ..,, .m. I 

IMSINJCTIOHS . 

1, ,3 RACE w.,,,, NE., . . .. E.8cA. 8“,,.., AGE- LA,, . . . . . s “,.. ..,,, , . .. :~&OFBIRIH 1“0.1., DAV. COUNTY OF DEATH ,,, \ s,,,,,”, s!.l”o.r IYt. m$) .0s DA,, “0””, .,. 

g 

~ 

4 50 5, SC 6 

: C177, TOWN, OR LOCATION OF DEATH ,.s!.! < s,,’,,, Cml U4m “,, m ,.., HOSPlrAL OR OTHER INSTITUTION—NWF(I*N.T’:” ,!!”,”, 0“, ,!ll, . . . . .“.,,, , 

. 

:

: SURVIVING smusE otwe.w M.,. -t, 

x mum”” , WIDOWED, DIvORCED [s,,<,,,, 

9 : ?::,’0’;:!2% 8 

,,.,. ,, M,m SOCIAL SECURIIY NUM8ER USUAL OCCUPATION <0s”, CN.mwo”< ,.., ,.”,.. .0$,0, KIND OF BUSINESS OR INDUSTRY 

: Occumm !. Wo, mw ,,,,, m. ,, ,,,,.,. , 

,& Mb 

: ::’;:s: %’’’”” ~E~,DENcE_~TA,E ~o”Nw CITY, TOWN OR LOCATION 8.s80! cm U.tri STREET AND NUMBER 

; i,,,c,w “,, m NO, 

~ ,,d 14, 

: 

,.,,,,,,,0., .,,, ,1 z 

: ,,,., !7 0, “.,.0. NO cm! 0“ row., n.!,, ZIP I 

m lob m M m : I : INJURY AT WORK PLACE OF ,NJURYA, H.M, ,,,,,,’. “,, 0“ .0, OFF!,, ,W..,, rc ,,,E,rm, 

!.”.,,,”,s,, ,.”0””, ~~~.,,~~ , $,*t,r m ,.,,0, NO , am 0“ row., sr.r, l 

I 

7 ,,,,,, 0, .,. .0 cm m row. WA,, z!? 

~ 

BURIAL, cmumON, REtAOVM CEMETERY OR CREMATORY —NAME LOCA11ON cm .“ !... ,7.,, 

T* 

% 14. 94, 24< 

,. DATE . . . . .. . . . . . ,,,., FUNERAL HOME—NAME AND ,LIDRESS ,,,,,, 0“ “.. o .0 <m m row., s,.,,, z,, , 

: lkd 1s, 

-+ FUNERAL DIRECTOR-SIGNAIURF IREGISIRAR—SIGNAT”RE [..,, ,,,,, ”,. ,“ ,0.., RFO,,T,A* 

Figure . United States Standard Certificate of Death used by physician, medical examiner, or coroner, 

spaces and differently worded certificationstate- the format will be similar to that already in 

ments are provided forphysicians andformedical effect for the live birth and fetal death certificates. 

examiners orcoroners. This will make possible an omission of certain 

Under the second alternative, a State would personal information from most certified copies. 

use two death certificate forms, one for phy- Questions on race, education, and previous mari­


sicians and the other for medical examiners or tal history will be placed in the confidential


coroners. The two forms are identical, exceptin sections.


the wording of the certification statements and This action was supported by most question-


omission of any reference to suicide or homicide naire respondents, but a majority of State vital


on the form for physicians. statistics officials do not favor it. The latter


R is anticipated that a majority of States believe that local government officials, who are 

will follow the first alternative. A few States now not under the authority of public health departuse two certificate forms and will continue to do ments, may not accept the confidential sections. 

so but as more Statewide medical examiner Marriage records have traditionally been treated 

systems are established, the two-form system as public records in local offices. However, the 

is likely to become more popular. National Center for Health Statistics believes 

Addition of “confidential sections” in the that the reasons for confidential treatment of 

certificates of marriage and divorce ov annul- certain information are as valid for marriage 

ment (figs. 6 and 7) ,—Confidential sections are and divorce as for birth certificates. 

proposed for these certificates for the first time; 

8 
OTHER ADDITIONS OR will provide useful information on the quantity, 

MODIFICATIONS if not the quality, of prenatal care, its variation 

among population groups of expectant mothers,

14number of other noteworthy changes were and its general relationship to infant and fetal 

made in the 1968 standard certificates. mortality. 

Live Birth and Fetal Death ,Certificates 

Death Certificate 

A question on the “date last normal menses 

be~an” was substituted for one on “completed “Name of surviving spouse” was added beweeks of pregnancy. ” Several registration areas cause it has been found useful for identification 

had male this change earlier on their own certifi- in inheritance, social security, and pension cases. 

cates. The resulting data were significantly im- If an autopsy was performed, the question “Were 

proved in that the heaping of reported gestations findings considered in determining cause of death” 

at :36 and 40 weeks was eliminated. Thus, the was added. The use of autopsy findings obviously 

change is expected to result in more accurate affects the reliability of cause-of-death certifinational data on premature births and relation- cation. 

ships between length of pregnancy and other 

variables, e.g., birth weight. Marriage Certificate 

Two questions were added on prenatal care, 

the “month prenatal care began” and the “total Additional identification of the officiant at 

number of prenatal visits. ” It is hoped that they the marriage as “religious or civil” was added 

,.,.,,,,0”,0 . , . . . . . . . . . . ,.!”, !.. .$, !.[ !,6, .,-,, !.66. 

,,..,, ,,”,,”.. N-”,,,, (MEDICAL EXAMINE. OR CORONER) 

r 1 U.S. 1
 STANDARD 

TYPE, OR PRINT IN mm, PM N“.*E” CERTIFICATE OF DEATH r $7.7, ml .“.,,” 

‘[ WRMAN[NT lNK /DEcfAsfD-NAk4E ,, ,s, .,..,, ,.s, $,6X DATE OF DfATH ( .0..”, ..”. “~.. ! 

IIAHD1OOK m 

Immnlons , 1 t 

RACE ‘+7”,1,, ME.”.. A. E”, CAM 8..8.., ;::;,C+:;,A,, , ..::,, I W.* . ..m 3 DA” ~J;; OF BIRTH t .0.1”. 0.7, COUNTY OF DEATH 

,,, , ,,,,,,”, ,.”s .0.”s .,. 3 

; 

: CIW, TOWN. OR LOCATION OF DEATH INSIDE cm Iwn HOSPITAL OR OTHER INsTnu1lON—NAME cIF .07 IN mm., OWE mm . . . 

< SPEW” “,$ m NO , 

.u.8Ee I 

. lb 11, i ld 

: STATE OF BIRTH r,, .07,. ., k . . . . C1llZEN Of WHAT COUNTRY MARRIED, NEVER MARWED. SURVIVING SFOUSE ,s5 w>,,, .,”, mm,. -E, 

r c.”.”” , WIDOWED, DIVORCED , ,,Ktm , 

9 10 II. 

5 

. 

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&mc”,,m ~“.~~, usuAL 

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CXCUPA11ON co,ve ,8.. .S WO.C . ..6...,.. ..s7 OF KIND OF EUS[NES5 OR INDUSTRY ,!,,, MN ,, ,,,,”,0, 

$ 

u 

!.,7, !,,,.., .,., 

.,s!.,.., ,,$. ”, .,.,,,,”. 

I& 

&lDENcE-sl ATE COUNTY 

13b 

CITY, TOWN, OR LOCATION 1“%1., C,W ,LW,, STREET AND NUMBER 

: , ,PKIF” “,$ 0, NO! 

: 148 14, 

: .,,,1, LAST MOTHER—MAIDEN NAME m“,. .,,.,, L.,, 

4 5, sk 5, 6 70 

I 16 

g MAILING ADDRESS ,,,, ,”., “ r... NO , cm m TOWN, $T.m, ,1, $ & 

~:

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A,, ”OXIM,, ,.,,./.,

[ENTER ONLY ONE cAusf PER IINE FOR (.), [bI, AND (CII IFIW,,N 0“,,, A.. ,,.,.

:3 

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;O”ilcg !:ANv,i ~:,: .,”O 

PART 11 01HER SIGNIFICANT CONDITIONS: c...!TN%N% . . . ..88.. (.. m mm *W . . . MM,. t. CAUSE GI.c. ,. PA.r I cm AUTOPSY IF YES “!”1 r!”.,.., c... 

, “!$ OR NO? ::CDK:,~N OCUKWNING -.S1 

f 

190 IVb 

i 

. ACC! DENT, SUICIDE. HOMICIDE, DAIE OF INJURY , M..,”, o,”, ,,. ”, HOUR now INJURY OCCURRED I mm .AWCC OF IN,.*Y t. r..r I o, �A., r,, ,rcMI, ! ~ OR UNDETERMINED CWECISVB 

.’ % 2oh m h! Wd 

5 INJURY Al WORK PLACE OF INJURY A! “0.6. F.”w ST”,*T. r.a.”r, LOCATION ( sr”ml O, “.F.O. .0, cm 0“ ,0”/., s.,, , 0,,,,, ,,,%, 

: m, M! 

CERTIFUATION-MmICAL . . ,., mm 0, t“, EXAMINEROR cORONER—., .,,.,.., ,,.,. CU.INATON..< UR,F. . . 

of r., ,., ..,, ,.., ..0 . . . . . . r“! ...,0,., ,N”tsu.. 

. ...,,%, 

no.,m s,,,,. ; 

$ DEATH OCCURRED THE DECEDENT WAS PRoNOUNCED DEAD f MOW”, OA”. “CA”, 

! ,,.”, ) 

: 21, 

; 

.

d, s?tclr” w! .“ .0) :,,,. ,,,,, !,” , 

m 

0 CERTIFIER—NAME t“,, m nt.? B mow m mu 

22~ ~ MAILING ADQRESS—CERIIFIER ,r”[m .1 R !.0 NO, c!” 0. TOWN s,.m n? 

: 8uR1AL, CREMATION, REMOVAL CFMEIERY OR CREIAATORY-NAME am m Tow” s,.,, 

Y , ,,[,,,” , 

: m 24b 

J DATE ,.0.1”, C.M, WA.) FuNERAc HOME—NAME ANO ADDRESS ( ,,,,,, 0“ “J... .0., cm m TOW., n.,,, z,. ! 

: Zy 1$, 

FUNERAL DIRECTOR-SIGNATURE [ REGIS1,WR-SIGNAIURE [ DATE RECEIVED lY 10CAL REOISIRAR 

‘igure !. Uni ted States Standard Ceriit icate OT Death used by medical examiner or coroner. 

9 
,0”. ..,”..,. ,. HYS, C, AN) “ s 6.”,””.,., ,“!”l !.. 0,,!,, !,,7 0,-,., -,,, 

,...,. ,“,,.” .0 6s-”,,0! 

r 1 U.S. Sl_ANDARD 

r 1 TYPE, OR PRINT IN LO,*L ,11, .“.,,, 

CERTIFICATE OF DEATH sr.r, ),. . ...,, 

y[M”;”&; ~*K &cEA56D —NAMf ,!,,, .,.,,, ,.s7 SEX 0A7E0f DfATH I..NI.. W. rt.ti 

lMSINJCIIOHS , 2 1 

PACE “m,,. . . . . . . ... ”Luw tm.,AM *W-L.,, “.,,. z 7,.” “..,, , . . . DATE OF BIRIHI.ON,”. DAY. c0uNr7 of CfATH 

,!, (s)[,1,,, ,1”7.0.” !“,., s) .0, ..”s .0.,s .!. ~u, 1 

: 

~ 4 50 56 SC & 70 

F CIW, 10WN, OR LOCATION OF DEATH ,Nsr.ccm Lwrs HOsHTALom CxHm NsT,,”l,ON—NAMf !,, ”0, !. 0,”,,,. ,,, s,,,,,.”. . ...,,, 

; t s,,,,,, ,,, 0, .0, 

lb 7, Id 

: STATE OF BIRTH $,$ ...,. u s ., . . . . CITIZEN OF WHAT COUNTRY MARRIED. NEVER MARRIED, 5URVIVING SPOUSE ,N WAN, .6., ~mt. -t, 

, CO”m!r , WIDOWED. DIVORCED, ,,,,,N, 

. “,”., ,,,!0,.,, 8 ? 10 11 

: :V.CID,, .::~oA,*;,.H ~~~lA~ ~~~uR,Ty ~uMBER USUAL OCCUPATION ,.3”, <,”O., wx. .0. ,.”.,” ..0,,0, KIND OF BUSINESS OR INDUSTRY 

: OCc”.”m !. Wotm,,o ,,,,, EYE” ,, .,,,,,, , 

& ‘“~t$’u’fo~~ ,,s,, !.,, ,,,0”, G,”f ,Z lb !3b 

“ . . ..s$.0” RESIDENCE—STATE COUNW CITY, TOWN, OR LOCA11ON ,.,,., .,” ,IAu,, S,REEl AND NUMBER 

z {s?rc!rr Yt, 0“ NO! 

; !4d 1(, 

.,,.,, m,, MOTHER—MAIDEN NAME nln M,m,, L.,, 

16 : 

. MAILING ACORESS ,Sm,,. 0, , ,.. “o cm 0“ row., s!.,,, ,!, } 

: 

tlb 

:6$3 DEATH WAS CAUSED BY. [FNlfRONLv 0NEuu5E pfRttNf fOR{.j, fbj, AND WI .r,.cx,*rc 

,[?!”(,. ..,,!. 

,.,(..., 

”0 .,.!” 

,? !1 ,..,,,,,, ‘.”,, 

~: 

:-j [.1 

,“, !., . . ., . <..,,0 .,.., 0, 

I 

# CWo”yt.jrm,s{ m,:.,,6 [b) ~ ,..,.,.,, ,.”,, !.,, 

> S,.71.0 ,., . ...,. OUE r.. 01 .,. COM$~OUWC~ OF ,“,.. . . . . . ,,,, 

: (Q < 

z’ PART 11 OTHER 51GNlFIcANT c0N01110Ns co.oir(o.s co.r.zB.7 (.. r. m.,. 8.TNO,Ztmrt.rOC..3t.8VE.,. ,.tr t c., ALJlO?SY 

!,,, m .0! 

IF YES 

slum,. 

w,”, ,,.O, ”.s 

1“ 0,,,,. !”!.. 

,0.. 

CA”,, 

: ,.; 0,.7. 

!* 

3 ACCIDCN, C,A,EOF ,N,”R” HOUR WOW INJURY OCCURRED !,.!,” ..,”,, .5! ,“,. ”, ,“ ,,,, , .,,.”, ,,, ,,(. ,,, 

; ,s~c’cw 765 on “01 ,,”0.,., 0.,, ,,. ”, 

20D 10b ?0< M 208 : INJURY AT WORK PLACE OF INJURY AT “0.!, ,.”., s!,11!. I.C!O.1, LOCATION {sll, ”.. ,,. NO C,N 0“ ,..”, ,!NI $ 4s,,,,,, ,,s .“ .0, 0,,,,, m.. ,,, !,, [,)!”1 z 

; CERTIFICATION– ..... 0.. .lM -0”,. 9.. “6.”
 ., ,., ,,,,,, . . ,“, i PH,s!c!,. ..,,. ..0, ,0 r., 

g .,.,.>1. ma. 

< 

s 2?. ~ CA”,,,,, sr,rm 

m PHYSICIAN—NAME ‘1,,$ 01,,’”~1 DATE SIGNED !“0.,”, ..,, “,”,, 

; 21,

MAILING ADDRES5—PH?SIC(AN ST.,,! c“.}. “. Owe. 7... $m! t ,1? 

,..t..m ,.[ To :::,,0 ,0:: s,;.,:, 

g 

BURIAL, CREMATION, REMOVAL CCIAmERY 0RCREM4T0RY -NAME 01% m ,m”” ,!..1, 

7 , ,Ptc!,l 

~ 2<. 24b 

DATE . . . . . . . . . . . ,,.,, FUNERAL HOME- NAMEANDADDRES$ ,1”,,. 0“ .r. . . . on 0,70W”, s,.,,, ,!, ! 

: 150 

t!! E8AL DIRE~OR— sfGNAruRE REGISTRAR-SIGNATURE OA,E “,,,, ”,. ,, ,!XA, “,.,s,,., 

@ lb 2U 

Figure 5. United Sta’m~ Standard Certificate of Death used by physician.


to provide informationon a factor that has shown If this was not the couple’s first marriage, 

a significant relationship with marriage stability. a new question is asked on the’ ‘number of previous 

Also, a question on “datelastm arriageended,” marriages ended by death or by divorce or an. 

for second or higher order marriages, in con- nulment. ” Finally, the new certificate asks forth: 

junction with the question on mode of termina- total number of living children as well as th ~ 

tionof the last marriage,will provideinformation number under 18 years of age. This will permj t 

on duration of widowhood and divorced status tabulations of more uniform information sines 

prior to remarriage. some States now ask for the total number 

some only for children under 18 years. 

Divorce Certificate 

ADDITIONS CONSIDERED, 

A question on “approximate date couple BUT NOT ADOPTED separated” was added to this certificate. This 

date usually marks thedefacto end ofthe marital Live Birth and Fetal Death Certificates 

union andcan be used, with the datesofmarriage


and divorce, to compute the actual comparedwith Addition to the live birth and fetal death


the legal duration of the marriage. Name of “at- certificates of a question on “Date of mother’s


torney for plaintiff” was also added to facilitate first marriage” was recommended by demog -


additional inquiries to the person who usually raphers and by the United States National Corn-


supplies the information concerning the husband mittee on Vital and Health Statistics. This infor -


and wife. mation is obtained in a number of other countri~s


10

and is recommended by the statistical office of the 

United Nations as needed for the study of child 

spacing. However, the directors of State vital 

statistics offices almost unanimously opposed the 

question. They believed that it would not be answered or answered incorrectly in cases where 

there had been more than one marriage or where 

pregnancy occurred before marriage. The question might also be illegal in States which by law 

forbid any question on legitimacy of the child. It 

was added to the fetal death certificate in Minnesota in 1966 on a trial basis and encountered 

strong objections from hospitals. Reconsideration 

of the arguments pro and con resulted in a decision to exclude the question. 

Addition of the Social’ Security numbers of the 

father and mother was proposed. The principal 

argument emphasized their potential usefulness 

in linking individual and family records for research purposes. Opponents felt that there was 

m,. .,,,. ”,. LICENSE NO. 

,“0.,7 ,“”,.” NO ,,-,,,,, 

little hard evidence that the numbers would be 

frequently or significantly used in this way and 

that the numbers should not be included until an 

actual, demonstrated public need existed. It was 

decided not to include the Social Security numbers 

of parents. 

Death Certificate


Although a large majority of persons favored 

addition of the name of the surviving spouse, the 

margin favoring addition of his or her age was 

much smaller, with the State registrars overwhelmingly opposed to it. Proponents stressed the 

usefulness of the information in studies of social 

problems of widowed persons; opponents ques ­

tioned the reliability of the information and its 

necessity. Thus, it was not included. 

Opinion on addition of the birthplaces of the 

father and mother of the decedent was abut evenly 

r 7 

U.S. S7AFIEIARD 

COUNIY DATE CERTIFICATE OF MARRIAGE sr.,cm . ..m w;;wyMyi;Ny ~~,J~_Nm~ ,,.$, .,..,, u,, 

lb 2, 2d 

;REE1 AND NUMBER sTArE OF B!RTH f,, .0, I. .,s..,, . . . . DATE OF BIRTH 

,0.”7””, 

lMO”m, ..?, YLA~I 

2,, 4 

FATHER-NAME STATE OF BIRTH III NOT ,. u.s.A., 

NAM, ..””,., ) 

;OrHfR—MAIDfN NAME 57*TE OF BIRTH or . . . I. . s.. 

N.*, ,...,”,, 

. 

$. Ih 6. ‘b 

BRIDE - NAM ,,,,, .,,.,, MST MAIDEN NbME (,’ .,,,,,,.7 ! 

n 

kpENcE-5TA1f COUNTY CIW. 10WN, OR LOU11ON ,.S!.E 

!,, 

C,ri 

., 

L,*,,S 

,,,,. ,,, ,,., 

lb ,, w 

:REEl AND NUM8ER 3TATE OF BIRTH i M w IN U. S.A., ..., .0”.,,, ! 

DATE OF BIRTH ! *NW. c..”, .,.1 ) 

1, 10 

FATHER--NAME STATE OF BIRTH c,1 HOr m u s.... k07HER—MAIOEN Nbw STATE OF BIRTH ( w .0> !“ “ s.,., 

. . . . ..”.,,, , “AA, ,0”.,””, 

It, llb 110 1m 

APPLICANT—SIGNATURE DATE SIGNED u-own. DAY. we I 

APPLICANT-SIGNATURE DATE SIGNED t .O”l” . . . . . WA* I 

~. I >s !&b 

~: 

< 

1lb 1$, 

DATE SIGNED ,.0.,.,..,, ,,.”, OR, C!ANT-.mO,Ou, o, ,,”,, < ,,u,t” t 

s 1Sd 15, ,,1 ~ 

WmNESS—SIGNAIURE W llNESS--S1GNArU~ 

2	

. Its Mb 

Low OFF,.,., kw.tw u.un. m mm u.tm o whmww DATE RECEIVED BY LOCAL OFFICIAL I A!O.r”. 0.,. ,CA, ) 

17, SIGNAIURE m CONFIDENTIAL INFoRMATION 

NUM,ER OF IF PREWOUSIY mRRIED EDucATlON — SPECIfY HIGHEST GRAOE c0MPLf7fD 

w“,,,, .,.,., ,., ”,,,. . . . .. . . ,!, 

18 19. zoo lob 2, I I 

WCE—8R1DE .“.,,, 0, 

,“,s mm,.., 

IF PREVIOUSLY MARRIED 

,.s, ..””,.., .A,, 

ECUCATION-SPEC1FY HIGHES1 GRADE 

1,,.,.7.., “,.. s<”.., 

COMpLETED 

<.,,,., 

w“,,,. .,.,0, ..!”,,.. ,.0(.., H,. ,!,,,, ,,.0.., 

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,,,, ,,,,’, ,,, , ,,,, ,,,, ,, ,!, , >,,, ,, ,+! 

,Swcllr, 

~! 11, ?4, 14b 1$ 

“ s Govcn”.mr **! NTING OFFICE !967 0-24 !-663 

Figure 6. United States Standard Certificate of Marriage. 

11 
0“. Ar!mvm 

wow sm.. . . 68-. w4 r 1 U.S. sTANOARO CERTIFICATE OF r 1 

WP6. OR PRINT IN ,.,., m, .“.,,, ABSOLUTE DIVORCE OR ANNULMENT s,.,,:!,,.“.,,” 

PERMANENT INK /Husband_ NAME ,I,,r .,0.,, I.,, 

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RESIDENCE—SIATF CITY. TOWN, OR LOCATION (s,[,,,, ,,, ., “o, 

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: 8 

: PLACE OF THIS MARRIAGE —COUNW STATE ($, . . . .. “s. , MA., mu.!””,	 DATE QFmK I.O.TH, .AT, YE-I ~o;p~:t~:,:::: c.Q.W ~~A,I 

MARRIAGE 

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~ LIVING cHItOREN-TOrAL NuM6ER uNDER 18 YEARS PLAINTIFF .“,,..,, .1,,, 07.,, ,sPEcl,r , 

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< LEGAL GROUNDS FOR DECREE $ VKW”I COUNTY OF DECREE DATE OF RECORDING ,..NT”, m., ,,.”, 

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2 COURT OFFICIAL—SIGNAKME TlnE OF COURT OFFKIAL COURT—NAME 

< 

14, ,4, 

: 

CONFIDENTIAL INFORMAnON 

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~ RACE—HUS8AND EDUCATION — SPECIFY HIGHFST GRADE COMPIEIED 

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~ RACE— WIFf NUti,m 06 ,”,, IF PREVIOUSLY MARRIED f DUCATION— SPECIFY HIGHEST GRAD f coMPLF1m MA”IIAGE How MANY ,.0,. w 

f

i y.,,,, .,.,., w,,,,.. ,.,,.., ,,, m$r, ,,<0.,, .,.,” m“.”,, 0, ,,6.,.,.,” .)0” 5c”om Co:ltm 

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(W,cm” I lr.o.r! 

,..”,.,., ,.,, ,,,4, ,, ,, ,,, ,,, ,! !,, ,,0,, +, : 

,19 m 11 . I 71 ~ .s Go”cm”. c”r PRr”TJ”G.r, !cc ,,’?. r—z. i-”. 

~ 

Figure 7, United States Certificate of Absolute Divorce or Annulment, 

divided. Theprincipal use cited was inepidemio- cate, none of those proposed by the NCHS or sub..


Iogical studiesof the relationships betweenethnic mitted to respondents in either of the question..


or cultural factors and mortality from various naires were excluded.


diseases. The accuracy of such information was


questioned, as well as its value, considering the


space limitations of the death certificate. Divorce Certificate 

A majority of respondents thought that the 

medical certification section should bemadecon- The place of final separation of the divorced 

fidential and not reproduced on copies of death couple was proposed. However, it was not considcertificates. The State registrars opposed this ered as important as the date of separation, whict L


step by a two to one majority. They felt that it was added. Therefore it was excluded from thu


would compel adoption of a separate form for standard certificate.


medicolegal deaths, because records of investi- Addition of the age and sex of each child wat:


gation of such deaths are public records. Also, proposed to obtain information useful in analyzinf;


there would be strong opposition from the insur- the effects of divorce on dependent children. P


ance business. majority of respondents answered favorably but


the State registrars opposed it by a substantial 

Marriage Certificate margin. They felt that such information would not 

be of sufficient value to justify the effort tc, 

Although there were a number of other items obtain it. These questions were not included, 

proposed for inclusion on the marriage certifi12

DELETIONS 

The question tlIs residence on a farm” was 

deleted from the live birth, fetal death, and 

death certificates. It had been added in the 1956 

revision at the request of the Department of 

Agriculture and the Bureau of the Census. At 

the time it seemed that this information obtained 

on the vital records would be relatable to that 

obtained from a similar question in the 1960 

population census. However, the definition of 

“farm” was changed in the 1960 census so that 

the resulting data were not comparable with the 

data obtained on vital records. Since valid vital 

rates by farm or nonfarm residence could not 

be computed it was decided to omit the question 

from vital records. 

The questions on usual occupation and kind of 

business or industry were replaced on the live 

birth, fetal death, marriage, and divorce or annulment certificates by a question on highest 

grade of school completed. The reasons were 

stated in a previous section. 

A question on service in the Armed Forces 

was also removed from the death certificate. This 

action was favored by all groups of respondents 

by the ratio of four to one, on the ground that the 

information was not needed by most State governments or the Federal Government. 

DESIGN AND PRINTING 

Early in the history of this revision the 

PHCRS Study Group on Structural Format of 

Standard Certificates formulated certain principles to be followed: 

1.	 Each item should be specified and arranged to facilitate preparation of the 

certificate and to maximize the accuracy 

and completeness of the reported information. 

2.	 In view of the extensive present use of 

microphotography and probable increased 

use in the future, microfilming requirements should be thoroughly considered in 

the design and physical characteristics of 

the certificates. 

3.	 Location, spacing, and wording of each 

item should be selected for maximum 

facilitation of record retrieval and data 

processing. 

A number of more specific decisions were 

made during the evolution of the forms: 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10.


11. 

Word and arrange similar items in the 

same way on all certificates. 

Limit the number of different types used 

in the certificates. (Three different sizes 

of the same type style were used in the 

body of the final certificates.) 

Use open-face rather than bold-face type, 

to avoid over-shadowing the reported 

information and to improve microphotographic reproduction. 

Place printed item headings as close as 

possible to the line above, to leave maximum space for the entry of information. 

Do not use reverse side of certificate for 

reported information. 

Consider both vertical and horizontal 

spacing and attempt to allow space proportional to the information requested. 

Plan for pica type and double spacing for 

all items. The death and fetal death certificates are crowded, so that only one and 

one-half spaces could be allowed for certain items. 

Position the item heading above the typing 

line so that the typist can see what is to 

be entered. 

Use check boxes only where there is clear 

evidence that they will result in better 

reporting. They require more space than 

can be provided in a space-limited form. 

Provide for cross-referencing related 

documents, such as birth certificates of 

multiple births, and live birth and infant 

death certificates for the same infant. 

Do not exceed the dimensions 8X” x 7%”, 

a size which is as large as or larger than 

13 
the 1967 forms of a majority of theregistration areas. It was recognized that a 

larger size would be preferable for the 

fetal death and death certificates which 

are somewhat crowded. However, increased certificate dimensions would not 

be accommodated by the existing filing 

equipment in many State and local offices. 

12.	 Group related items, and lead the informant to each group by prominent’ ‘locator” 

words or headings. 

The final standard certificate forms evolved 

from numerous earlier drafts prepared during 

the period 1964-67. The early drafts were done 

on an ordinary typewriter which did not permit 

variations in size or style of type. 

The final forms were designed with the assistance of a professional forms design specialist 

who worked closely with the staff of the Division of 

Vital Statistics. Numerous drafts were prepared 

and reviewed. The review of forms, in which 

spacing, wording, and size of type are important, 

is a difficult, time-consuming task. There are 

literally hundreds of ways in which errors or 

inconsistencies can occur in these drafts. 

When acceptable drafts were ready for printing, a member of the staff and the forms design 

specialist conferred with the forms design staff 

of the Public Health Service who provided liaison 

with the Government Printing Office (GPO). The 

final printing of the certificates was done by GPO. 

The proofs of the certificates were obtained and 

carefully reviewed. Second proofs were necessary 

because the GPO printers first treated the forms 

like ordinary questionnaires and not as permanent 

records, in which all of the limited space had to 

be used most efficiently and the spacing of items 

and size of type, had to be precise and carefully 

chosen. 

IMPLEMENTATION 

The original time schedule for revision of 

the standard certificates called for distribution 

of the new forms to the States approximately one 

year before the revised State certificates would 

be in use, to allow the States time to draft their 

own forms, obtain approval, print, and distribute 

them. After amendment of the original schedule, 

the effective date for the new certificates was 

January 1, 1968. Therefore, the NCHS hoped to 

complete final drafts of the new certificates and 

print and mail them to the States in January 1967. 

However, the printed certificates and associated 

materials were not ready for distribution until 

April 1967. 

Copies of the new standard certificates were 

sent to all State and independent registration 

area health officers with an accompanying letter 

from the Surgeon General of the Public Health 

Service, urging adoption of all items in the new 

certificates. A few days later copies were sent 

with a letter from the Director, NCHS to the 

chief registration executives of all States and 

other registration areas. In addition to the printed 

certificate forms each area received a brochure, 

“United States Standard Certificates, 1968 Revision, ” which explained in detail the reasons for the 

format and content changes. Glossy print and 

reproduction-negative copies of the new certificates were also provided to facilitate minor 

modifications that might be necessary in States 

wishing to adopt the standard certificates with 

only minimum changes. 

The NCHS offered direct technical assistance 

in drafting the new State certificates to all States 

requesting it. Approximately a dozen areas asked 

for such help with their revised forms; about 10 

other areas forwarded their proposed new forms 

for comment, but did not request assistance. 

In support of the new standard certificates, 

a series of instructional handbooks were prepared 

for distribution to persons responsible for the 

registration of live births, deaths, and fetal deaths. 

These handbooks were printed and distributed to 

all States during the first five months of 1967. 

They were: 

Physicians’ Handbook on Medical Certification: Death, Fetal Death, Birth 

Hospital Handbook on Birth and Fetal Death 

Registration 

Funeral Directors’ Handbook on Death and 

Fetal Death Registration 

Medical Examiners’ and Coroners’ Handbook 

on Death and Fetal Death Registration 

These handbooks contain discussions of the 

use of the certificates and the importance of 

entering correct information, and specific instruc ­

tions for completing each item. They were de14 
---------- ------------

signed as models, based on the new standard certificates and the Model Vital Statistics Act of 1959, 

which could be adapted by any State to reflect 

its own laws and regulations, or could be distributed by the States as published. The choice of 

the States between these two alternatives by 

November 1967 was: 

Number of registration areas will 

Handbook 

Prepare Distribute 

own mode 1 

Physicians 40 

Hospital :: 32 

Funeral director---- 18 

Medi,cal exami,ner---- 14 :; 

Handbooks on marriage registration and divorce 

registration are in preparation and will be published later. 

An informational film strip on the registration 

of births and fetal deaths occurring in hospitals 

is in preparation. It is based on the new standard, 

certificates and is intended for showing to physicians, nurses, and clerks in hospitals, and it will 

require about 20 minutes to show. Plans are also 

being made to revise a previously issued film on 

medical certification of causes of death. This film 

is designed for showing to physicians, interns, and 

medical school students. 

000 

Many State vital statistics offices have held 

or plan to hold regional institutes for instruction 

of local registrars, hospital personnel, and funeral 

directors in the new State certificates that are 

based on the revised standard certificates. 

Several papers explaining the changes in the 

new certificates have been published or presented. 

Other articles are also planned for publication in 

appropriate journals. 

Grove, R. D.: The New Standard Certificates 

of Vital Events. Unpublished paper presented 

at the Annual Meeting of the American Public 

Health Association, Oct. 21, 1965, Chicago, 

Ill, 

Lunde, A.S., and Grove, R. D.: Demographic 

implications of the new United States certificates. Demography 3(2):566-573, 1966. 

Lunde, A.S.: Changes in Requirements for 

Basic Demographic Data. Unpublished paper 

presented at the Annual Meeting of the American Sociological Association, San Francisco, 

Calif., Aug. 1967. 

Lunde, A.S.: Revisions of U.S. Standard Certificates of Vital Events. Pub. Health Rep. 

82(10):913, Oct. 1967. 

Council, C .R.: Asking better questions about 

life and death. Med. Record News 38(5):310, 

Oct. 1967. 

15

-----------------

----------------------

----------------

-------------------

------------------------------- ------------ ----------------- -----------------

------------------- --------------------------- -----------------------

-------- -------------------------------- ----------------- -----------

Table 1.


2.


3.


4. 

5.


6.


7.


8.


9.


10.


11.


12.


13.


14.


15.


16.


17.


18.


DETAILED TABLES 

Contents of Standard Certificate of Live Birth, by year revised


Contents of Standard Certificate of Death, by year revised


Contents of Standard Certificate of Fetal Death, by year revised


Contents of Standard Certificate of Marriage, by year revised


Contentsof Standard Certificate of Absolute Divorceor Annulment, by year revised--


Re;~onses to Questionnaire on Revision of the Standard Certificate of Live Birth,


Percent of State Registrars and All Other Respondents Favoring Routine Certific­


ation of Items on Certificate of Live Birth, 1963------------------------------


Re;;onses to Questionnaire on Revision of the Standard Certificate of Live Birth,
 --------.


Responses to Questionnaire on Revision of the Standard Certificate of Death, 1963-


Percent of State Registrars and All Other Respondents Favoring Routine Certifi­


cation of Items on Certificate of Death, 1963-----------------------------------


Responsea to Questionnaire on Revision of the Standard Certificate of Death,


l965----------------------------------------------------------------------------


Responses to Questionnaire on Revision of the Standard Certificate of Fetal


Death, l965---------------------------------------------------------------------


Responses to Questionnaire on Revision of the Standard Certificate of Marriage,


l963----------------------------------------------------------------------------


Percent of State Registrars and All Other Respondents Favoring Routine Certifi­


cation of Items on Standard Certificate of Marriage, 1963----------------------­


~e;onses to Questionnaires on Revision of the Standard Certificate of Marriage,
 ---.----


Responses to Questionnaire on Revision of the Standard Certificate of Absolute


Divorce or Annulment, l963------------------------------------------------------


Percent of State Registrara and All Other Respondents Favoring Routine Certifi­


cation of Items on Certificate of Absolute Divorce or Annulment, 1963-----------


Responses to Questionnaire on Revision of the Standard Certificate of Absolute


Divorce or Annulment, l965------------------------------------------------------


rage


18


20


22


24


25


26


29


30


32


35


36


38


40


41


42


44


45


46


17

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------------------------------------

---------------------------------------

------------------------

-------------------------

---------------------------------------

------------------------------

------------------------------

---------------------------------

------------------------

-------------------------

-----------------

-------------------------------------

----------

------------------------

--------------------

---------------------

-------------------------

------------------------------------

-----------------------------

------------------------------

---------------------------------

---------------------------------

-----------------------

------------------------------

---------------------------

Table 1. Contents of Standard Certificate of Live Birth, by year revised


-: 

Item 1900 1910 1915 1918 1930 1939 1949 1956	 196,3 

—-

Place of birth


County x x x x x x x


Township, or------------------------------- x x x x x


Village, Town, or-------------------------- x x x x x x x


City x x x x x x x


Address x x x x x x x


Ward x x x x x


Name of hospital or institution


in lieu of address x x x x€

Inside city limits x x


Child information


Name x x x x x x x


Sex---------------------------------------- x x x x x x x


Date of birth x x x x x x x


Hour of birth x x x x x


Legitimacy x x x x x x x


Multiple birth----------------------------- x x x x x x x


Order of birth----------------------------- x x x x x x x


Premature or full term--------------------- x 

Months of pregnancy - x 

Weeks of pregnancy x


Date of last normal menses


Weight x


If stillborn, period of gestation x


Cause of stillbirth x


Birth injuries to child


Congenital malformations


or anomalies of child


Mother information


Full (maiden) name x x x x x x x


Age---------------------------------------- x x x x x x x


Residence (usual)-------------------------- x x x x x x x


Rural x x€

Within city x x


Color or race x x x x x x x


Birthplace x x x x x x x


Occupation x x x x x x


Business or industry x x x


Years at work x


When last worked x€

x X 

x x 

x x 

x x 

x x 

x x 

x x 

x x 

x x 

x 

x x 

x x 

x x 

x 

x 

x x 

x 

x 

x x 

x x 

x x 

x 

x x 

x x 

x x 

-

18

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---------------------

-------------------------------

--------------------------------

---------------------------

----------

----------------------------

--------------------------

----------------------------------

--------------------

-------------------

------------------

------------

---------

-----

---------------------

----------------------------------

----------------------------------

---------------------------------

------------------------------

---------------------------------

-----------------------------------

---------------------------

----------------------------------

---------------------

-------------------

---------------------

------------------------------

------------------------

----------------------------------

---------------------------------

---------------------------------

----------------------------------

------------------------

Table 1. Contents of Standard Certificateof Live Birth, by year revised—Con.
 _ _ _ _ 

Item 1900 1910 1915 1918 1930 1939 1949 1956 1968


Mother information—Con.


Children previously born x x x x


Born alive, now dead x x x x x x


Now living x x x x x x x x x


Stillborn


Time in hospital.or institution


before delivery


Time in community before delivery


Mailing address


Residence on farm


Education


Date of last live birth


Date of last fetal death


Month prenatal care began


Total number of prenatal visits


Complicationsrelated to pregnancy


Complicationsnot related to pregnancy


Complicationsof labor


Father information


Full name x


Age----------------------------------------x


x x x x x x 

x


x


x x


x 

x 

. x 

x 

x 

x 

x 

x 

x 

x x x x x x x x


x x x x x x x x


x x x x


x x x x x x x x


x x x x x x x x


x x x x x x x


x x x x x 

x 

x 

x 

x x x x x x x x


x x x x x x x x


x x x x x x x x


x x x x x x x x


x x x 

x x X x x x x x


x x x x x x x x


x x x x x x


x x x x 

x x 

Residence


Birthplace


Color or race


Occupation


Industry


Years in work------------------------------


When last worked


Education


x 

x 

x 

x 

Certification


Certificationof birth


Signature of certifier


Address of certifier


Date signed


Type of attendant


Registrar


Date filed


Name added


Informant


Relation to child


x


x 

x 

x 

x 

x 

x 
-------------------------------------------

---------------------------------------------

------------------------------------------

---------------------------------------------

-------------------------

--------------------------------------------

---------------------------------------------

------------------------------------

----------------------------

---------------------------------

------------------------------------

-------------------------------

-----------------------------------

----------------------------------

-----------------------------------

---------------------------------------

----------------------------

-------------------------------

-------------------------------

----------------------------------

--------------------------------

--------------

--------------------------------------

-------------------

---------------------------

-----------------------------------

-------------------------------

-----------------------------------

-------------------------------

------------------------------------

-----------------------------

Table 2. Contents of Standard Certificate of Death, 1 year revised


Itern 1900 1910 I-918 L930 1939 I-949 1956 .968


Place of death


County x x x


Towmship, or------------------------------------- x x x


Village, town, or-------------------------------- x x x


ciey x x x


Address x x x


Ward x x x


Institution or hospital,


name in lieu of address x x x


Rural


Inside city limits-------------------------------


Decedent information


Name x x x


Sex---------------------------------------------- x x x


Color or race x x x


Age:


Years, months, days x x


Hours, minutes i x


Date of birth x x x


Birthplace:


State or country x x x


City or town----------------------------------- x


Marital status x x x


Spouse’s name x


Age if alive


Occupation x x x


Business or industry--------------------------- x x


Years in occupation


When last worked


Name of employer x


Residence-inside city limits---------------------


Usual residence x x x


Residence on farm


Length of stay where death occurred x x x


If foreign born, how long inu.s.----------.----- x


Citizenship


If veteran, war, service dates


Social Security number


Name of father x x x


Birthplace:


State or country x x x


City or town x


Name of mother (maiden)-------------------------- x x x


Birthplace:


State or country x x x


City or town----------------------------------- x


Medical certification


Date of death x x x


Period of care----------------------------------- x x x


Date last seen alive x x x


x x x x x


x x


x x x x x 

x x x x x 

x x x x x 

x 

x x x x x 

x x -

x x 

x x x x x


x x x x x


x x x x x


x x 

x	 x i i :


x x x x x


x x x x x 

x x 

x x x x x


x x x


x


x x x x


x x x ;


; - -

x . 

x x 

x x x x x 

x


x x x x


x x 

x x x 

x x x 

x x x x 

x x x x x 

x x 

x x


x x x x x


; : 

x x x x x


x x x x x


x x x x x

------------------------------------

-----------------------------------

-------------------------------- ----------------------------------

-------------------------------- ----------------------------------

-------------------------------- ----------------------------------

---------------------------------

------------------------------

----------------------------------------

-------------------

------------------------------------------

------------------------------

------------------------------ ----------------------------------

----------------------------------

-------------------------- ----------------

-------------------------------

-------------------------------

---------------------

-----------------------------

--------

--------------------------------------

---------------------------------------- --------------------------------------

-------------------

----------------------

--------------------

------------------------

------------------------------

---------------------------------------- -------------------------------------

Table 2. Contents of Standard Certificate of Death, by year revised—Con. 

Item 1900 1910 1918 1930 1939 1949 

Medical certification-Con. 

Time of death x x x x x x€

Cause of death x x x x x x€

Duration (days)--------------------------------x x x x x


Months, yeara x x x x


Date of onset x€

Contributory cause (l)--------------------------- x x x x x x


Duration (dada)--------------------------------x x x x x


Months, yeara x x x x


Date of onset x€

Contributorycause (2)--------------------------- x x€

Duration (days)-------------------------------- x ;


Months, years x x


Date of onset x€

Other conditions x x


Physician signature x x x x x x


Date-------------------------------------------x x x x x


Address x x x x x x


Physician’sname-type or print€

Operation, date of------------------------------- x x x x


Autopsy x x x x


Confirmed diagnosis x x€

Death from violence x x x


Type-------- - x x x x x


Date occurred x x x


Hour----------------------------------------- x


Geographical location x x x


Industry, home, or public place x x x


Manner of injury x x x x x


NaWre of injury x€

Milq at work---------------------------------- x x


If dlse$lse,where contracted x x x


Occupationaldisease x€

Separate medical examiner, certification .€

Disposition of body 

Place of:€

Burial, Removal;-------------------------------x x x x x€

Cremation x x x ;


Date---------------------------------------------x x x x x x


Undertaker’sname-------------------------------- x x x x x


Address x x x x x x


Signature€

Funeral home-name and address€

Specify type of diapoaition x x


Name of cemetery or crematory x


Other information 

Informant’scertification x x


Informant’sname--------------------------------- x x x x x x


Informant’saddress x x x x x€

Registrar x x x x x x


Date filed x x x x x x


1956 L968 

x x 

x x x x x x 

x x x x x x 

x 

x : x x 

x x 

x x x x x x 

x 

x x 

x 

x x x x x x x x 

x x x x x x 

x x 

x 

x 

x : 

x x 

x 

x x 

x 

x x 

x x 

x x 

x x 

x x x x 

21 
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---------------- ------------------------------------------------

------------------------------- -------------------------------

-------------------------------------------------- ----------------------------------------------- --------------------------------------------------------

------------------------------------------------- ----------------------------------------------- ------------------------------------------- --------------------

-----------------------------------

----------------------------------------------------------- ----------------------------------------------------- --------------------------------------------------------

-------------------------------------------------------- ----------------------------------------------

-------------------------------------------------- ------------------------------------------ ------------------------------------------ ------------------------------------------------------

------------------------------------------------------- -------------------

--------------------------------- --------------------------------------------------- --------------------------------------

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---------------------------------------- --------------------------------------------

-------------------------------------------

------------------------------------------

----------------------------------------- -----------------------------------

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--------------------------------------------------------- ------------------------------------

----------------------------------------------------- ---------------------------------------------------------

-------------------------------------------------------- ------------------ -------

--------------------------------------------------

Table 3. Contents of Standard Certificateof Fetal Death, by year revised


Item 19301 1939 1949 1956 1968


Place of fetal death


County x x x x


Township or------------------------------------------------------- x


Village, town or--------------------------------------------------;
 x x


City ----. x x ; x


Address x x x x


Ward--------------------------------------------------------------
 x


Name of hospital or institutionin lieu of address x x x x


Inside city limits x


Child or fetus information


Name x x x x


Sex---------------------------------------------------------------x
 x x


Date of delivery x x x 1


Period of gestation x x x x


Legitimcy x x x x


Weight------------------------------------------------------------ x x


Multiple delivery x x x x


Order of delivery x x x x


Birth injuries to fetus


Congenitalmalformationsor anomalies of fetus


Mother information


Full (maiden)name------------------------------------------------x x x x


Age-----..----­
 ----.----.------ - x x x 

Residence (usual)-------------------------------------------------;
 x x

Rural x ;


Color or race x x x


Birthplace x x x ;


Occupation x
 Business or industry i x
 Years at work----------------------------------------------------­
x 

When last worked


Children previously born :


Born alive, now dead x x x x


Now living x x x


Stillborn x x ; x


Time in hospital or institutionbefore delivery x


Time in communitybefore delivery


Mailing address E


Residence within city limits x


Residence on fam------------------------------------------------- - x


Education -.


Complicationsof pregnancy


Complicationsof labor


Date of last live birth


Date of last fetal death


Month prenatal care began


Total number of prenatal visits


Father information


Full name x x
 Age----------- ---_---_-------- x x : ;


Residence x


Birthplace------..----­
-----.- x x x x 

Color or race x x x x


Education


Occupation x x x x


Industry .-------------------------------- x x x x


Years in work----------------------------------------------------- When last worked ; 

22

---------------------------------------------------- -----------------------------------------------

--------------------------------------------

------------------------------------------------

----------------------------------------------------------- ----------------------------------------------- --------------------------------------------

-------------------------------------------- ------------------------------------------------------- ----------------------------------------------- --------

-----------------------------

------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------- ------------------------------------

-------------------------------------

-------------------------------------

---------------------------------------------------------

------------------------------------------------------ --------------------------------------------------

Table 3. Contents of Standard Certificateof Fetal Death, by year revised-Con.


Item 19301 1939 1949 1956 L968


Medical certification


Cause of death x x x x x


Fetal or maternal x x x x


Contributorycause (l) x x€

Contributorycause (2)-------------------------------------------- x x


Other conditions x x x x


When did fetus die----------------------------------------------x x x x


Autopsy x x


Confirmed diagnosis :


Operation for delivery x


Signature of physician x x : x x


Date signed x x x x x


Physician’saddress x x x x€

Signature of authorizedofficial, if physiciannot present x : x x


Disposition of body


Place of burial, cremation or removal x x x x x


Date--------------------------------------------------------------x x x x x€

Undertaker’sname x x x


Address x x x x


Signature x


Funeral home--name and address ;€

Specify type of disposition x x x x


Name of cemetery or crematory x x x


Other information


Registrar x x x x€

Date filed x x ; x x€

Given name added x€

lNot a separate certificate,question on stillbirth included on the live birth certificate;a


death certificatewas also filed.


23

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Table 4. Contents of Standard Certificate of Marriage, by year revised


Item 1956 1968


Characteristic of groom


Name x x


Residence x x


Inside city limits----------------------------------------------------------------- x


Date of birth x x€

State of birth x x


Race x x€

Number of this mrriage x


Number of previous mrriages x


Never mrried x


How laat marriage ended x x


Date x


Occupation x


Business or industry x


Education x


Father’s and mother’s names x


States of birth x


Characteristics of Bride


Name x x


Residence x x€

Inside city limits----------------------------------------------------------------- x€

Date of birth x x


State of birth x x


Race x x€

Number of this marriage x


Number of previous mrriages x


Never married x€

How last marriage ended x x€

Date x


Occupation x€

Business or industry x


Education x


Father’s and mother’s nams x


States of birth x€

Other items


Title of officiant x x


Date and place of ~rriage x x€

Date license signed x x€

Witness-signatme x


24

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Table 5. Contents of Standard Certificate of Absolute Divorce or Annulment, by year revised


Item 1956 1968


Characteristics of husband


Name x x


Residence x x


Date of birth------------------------------------------------------------------------ x x


State of birth----------------------------------------------------------------------- x x


Race x x


Number of this marriage x x


Occupation x


Business or industry x


Education x


How previous marriages ended x


Characteristics of wife


Nam--------------------------------------------------------------------------------- x x


Residence x x


Date of birth x x


State of birth x x


Race x x


Number of this marriage x x


Occupation x


Business or industry x


Education x


How previous marriages ended x


Other items


Date of marriage x x


Place of mrriage x x


Date of separation x


Living children—total number x


Under 18 years of age-------------------------------------------------------------- x x


Plaintiff x x


Attorney for plaintiff x


Type of decree x


Decree granted to-------------------------------------------------------------------- x x


Legal grounds for decree x x


County of decree x x


Date of recording x x


Title of court official x x


comt x


25

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----------

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-------------------------------

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Table 6. Responses to questionnaire on revision of the Standard Certificate of Live Birth, 1963


Item


Retain as worded “If not in hospital,


give street address’’


Retain “Is place of birth inside


city limits’’


Reword !Iusualresidence of mother’’


Re.~m.s~~Is residence inside city
 . .


Retain “IS residence on a farm’’


Include “Hour of birth’’


Include “Date of birth of


both parents’’


Include “Age in years of both parents’’---


Include both these items for both


parents


“Date of birth for mother only” and


“Age in yeara for both parents’’


Include “Education: years of school


completed’’


Include “Education for mother only’’


Include “Education for father only’’


Include “Education for both parenta’’


Include “Education” as a substitute


for occupation


Include “Education” as an addition


Retain “Informant’’


Delete “Date on which given


name addedt’


Reword “Length of pregnancy in weeks”


to “First day of last normal menses’’----


Include date of first marriage


of mother


Include Social Security numbers -


of father and mother


Class of respondent


All respondents Registration


N=286 authority


N=47


. 

Not Not Yes No stated Yes No stated 

156 90 40 39 7 1 

163 54 69 27 14 6


89 135 62 20 25 2


124 31 131 25 8 14


49 149 88 1 40 6


194 31 61 38 9


69 ... ... 8 .0. ... 

102 ... ... 29 ,0. ... 

40 ... .*, 5 ..* .*. 

59 .*. ..* 4 ,.. ... 

171 78 37 15 26 6 

17 � .. � .. 1 . . . ..* 

5 ..* .0. .0. ... 

154 ... ... 15 . . . ... 

57 ... ..0 10 .00 ..0 

112 .0. ..0 6 . . . .** 

171 22 93 37 5 5 

49 58 179 14 9


125 66 95 17 21 9


120 92 74 5 35 7


157 79 50 11 31 5


Official health


agencv


ii-=74­


— — 

Not Yes No stated 

— 

40 25 9


40 16 18


19 46 9


35 9 30


6 44 24


55 6 13


8 ..* � ,. 

38 ... ... 

7 .*O � .. 

14 ... ..0


40 22 12 

3 ... ... 

1 ..0 ..0 

38 ... ... 

17 .,. ...


23 ..0 ...


48 4 22


10 18 46


32 22 20


22 29 23


35 24 15


26

---

---

---

---

---

Table 6. Responses to questionnaire on revision of the Standard Certificate of Live Birth,


1963-Con.


Class of respondent


Voluntary health Government health Other


agency agency (non-PHS) University 

N=75
 N=16
 N=39 N=35


Yes No stated Yes No Not Yes No Not Yes No Not Not

stated stated stated


22 12 5 13 14 8 34 27 14 8 5 3 

22 5 12 19 4 12 46 13 16 9 2 5 

9 21 9 12 8 15 25 29 21 4 6 6 

13 6 20 11 3 21 35 4 36 5 1 10 

7 17 15 4 13 18 25 33 17 6 2 8 

35 1 3 21 3 11 35 11 29 10 “1 5 

13 . . . ,.. 14 . . . ... 20 ..0 .*. 6 e.. . . . 

9 . . . . . . 6 . . . ... 15 . . . . . . 5 . . . . . . 

4 . . . . . . 5 . . . ... 17 .*. . . . 2 .0. . . . 

10 � .0 ..0 8 . . . .*. 21 .*. .0. 2 . . . ..* 

23 11 5 19 7 9 64 9 2 10 3 3 

2 . . . . . . .00 ... 9 . . . .:. � 2 . . . .0. 

..* . . . 2 . . . ... 2 .0. .*. . . . . . . 

21 ..* . . . 18 � ., .0. 54 .*. ..* 8 . . . . . . 

10 . . . . . . 8 . . . .*. 12 . . . . . . ..0 . . . 

11	 **, � *O 9 O.* ... 53 � .0 *.. 10 . . . . . . 

25 2 12 22 2 11 33 7 35 6 2 8 

7 4 28 8 27 8 11 56 2 1 13 

22 9 8 12 4 19 40 8 27 2 2 12 

11 13 15 19 3 13 55 9 11 8 3 5 

I 

17 13 9 26 3 6 61 7 7 7 1 8 

27

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Table 7. Percent of State registrarsand all other respondents favoring routine certificationof


items oriStandard Certificateof Live Birth, 1963


State All


Item registrars others


N=45 N=176


Date of first mrriage


Legitimte


Education


Birth weight-----------------------------------------------------------------


Length of pregnancy .-------


Children born, now dead


Fetal deaths


Other living children


Social Securitynwbers


Date of parents’ birth


Business or industry .........---------


Race of father


Usual occupation


Race of mother


Mother’s mailing address


Info~ant


Age of father


Age of mother


Father’s birthplace


Date given name added


Mother’s birthplace


Birth order


This birth (plurality)-------------------------------------------------------


Hospital


Residence of mother


Inside city limits


Hour of birth


Attendant’saddress


Type of attendant


Attendant’s signature


Date signed


Maiden name -.------


Registrar’ssignature


Name of faeher


County


Date received by local registrar


City, town, location


Sex .-------


DaCe


Name


1 

Percent


O.O 14.6 

2.7 8.6


3.3 18.4


11.6 23.7


11.6 31.3


13.9 26.7


14.3 23.8


18.6 27.3


24.1 48.2


37.5 35.6


39.0 44.8


40.0 29.0


40.5 46.5


40.9 30.5


41.5 58.8


50.0 65.0


52.3 53.8


54.5 60.5


54.5 52.5


57.6 55.4


59.5 56.9


62.2 71.2


62.2 75.0


67.4 83.1


69.8 79.5


70.0 71.0


7300 56.5


75.6 74.5


78.0 74.7


80.0 75.7


80.5 77.4


84.4 77.4


86,0 84.0


86.4 74.0


90.5 96.3


91.0 76.3


95.5 97.5


95.6 98.8


100.0 98.2


100.0 98.8


29

Table 8. Responses to questionnaire on revision of the Standard Certificate of Live Birth, 1965

-

T Class of respondent 

State registrars

N=33 

Item Persons in Public 

Health Service 

(includes NGHS staff) N=12 

All respondents

N=l08 

AP- Disap- No 

proved proved opinion -!---I- 69 7 32 

AP- Disap- No

proved proved opinion 

T !-J--

81 II 3 

25 4 4 

Additions 

Hour of birth-------------

Attendant's name----------

Education-----------------

Date of last live birth---

Date of last fetal death-­

During what month of 

pregnancy did prenatal care begin---------------

Mother's date of birth 

(month, day, year)-------

Medical information-------

Modifications 

27 5 1 

18 14 1 

57 27 19 11 3 

60 I I 19 29 20 7 6 5 i 

46 1 27 1 35 11 14 8 41 31 5 

16 11 6 31 31 ’

6

sz7 1 4 

13 34 Iv22 4- 63 

Name of hospital (if not 

in hospital give street address)-----------------

Informant-----------------

23 

117

24 

2 

35

41 

8 

53

03 

61 I 28 I 19 16 11 6 5 I 1 I 6 

Race of parents a. father b. mother----------------

Birthweight (no units specified)---------------

Date last normal menses 

began (month, day, year)­

Attendant at birth (M.D., D.O., C.M.N., midwife, other) specify-----------

15 12 6 6 I 1 I 5, 

20 5 8 4 I 2 I 6 i 

5 I I 42 1 26 1 40- 7

IL74 -34 

55 13 40 

36 33 39 

11 15 7 

26 7 

6 10 

16 7 

5 8 

J 

-I 6 1 

7 - 5 

6 

4 2 6 

4 - 8 

Deletions 

Is residence on a farm?---

Occupation and kind of 

business or industry-----

Mother's mailing address-­

Date on which given name added.------------------. 

17 

10 

59 9 40 20

'Signature with certification 

2Signature without certification 

3Name only %&i.;;~ ,ygrintendant's signature 

sNo opinion 

30 
Table 8. Responses to questionnaire on revision of the Standard Certificate of Live Birth, 1965_Con.


Class of respondent


I


Persons in State and


local health agencies Social scientists Other
 (including State N=5 N=15
 Health Officers)


Persons in all other


Federal agencies


N-11


Ap- Disap- No 

proved proved opinion -1-

31 - 8

4- 7


5- 6
 =4=

4 1 6


-t41 - 7 

T

6- 5


4 1 6


d=2- 9


12 31 5-

42 65 % 

6 2 3 

2 1 8


* 

4 - 7


3 - 8 

4 - 7


4 - 7 

3 1 7 

7


Ap­
 proved


26


27


20 

21


21


13


18


24


110 ’24 

19


18


21


11 

25


19


10 

21


N=32 

Disap- No Ap- Disap. No Ap - Disap- No 

proved opinion proved provec opinion proved proved opinion -1---t 1 5 2
 3 

10 

8 1 6 

21 31 1 1 3 T1 4 

11 I 11 3 2 

7 4 1 1 3 

6 5 3 1 1 

9 10 4 1 

12 2 3 1 1 

2 6 1 1 3 

39 3- 51 

4- :: :; 4- 63 

11 2 4 1 

10 4 1 4 

5 6 1 - 4 

11 10 2 3 

7 3 2


5 8 1 1 3 

13 9 1 4 I I 

3 8 2 3 

9 2 4


7 2 6


+ 

T 10 - 5 

6
 +-l+ 6 

9- 6
 T15 33 51


22
 41 63

11 2 2 

8 3 4 

10 - 5 

10 - 5 

9 - 6


8 1 6


8 1 6


9 - 6

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Table 9. Responses to questionnaire on revision of the Standard Certificate of Death, 1963


Class of respondent


Item


Place of death


Retain length of stay


Retain “within city limits’’


Usual residence


Should it be reworded


“Inside city limits: improve residence


statistics


Retain “Is residence on farm’’


Marital statua


Add name of spouse if living


Add age of spouse if living--------------


Open question preferable


Usual occupation or industry


Retain item------------------------------

Substitute II1aStII for usual Occupation---

Drop occupation, include education


Names of parents


Add birthplaces of parents


Question


Should medical certification


be confidential


Should item show whether autopay


findinga included


Uniform supplementary form for


revised certification


Expand manner of death item--------------


Provide for tuMannerundetermined’’


Identify hospital staff certification----


Reword coroner or M.E. certification


Provide two certification boxes
 on one certificate


Provide two certificates


Type physician’s name


Registration 

authority a~_gey 

N=47 I . 

Not Not Not Yes No stated Yes No stated Yes No stated 

. 

51 180 37 6 17 9: 129 16 5 26 :; x 

7C 174 11 30 6 22 48 I16 

105 28 13 34 18 34 

51 1% 4: 7 10 50 26 

208 38 36 9 54 10 22 

11s 8 ; 32 29 

34 2?: 3 % 5 9 % 17 

241 34 3 65 9 

59 1% :: K 

66 64 16 2; i: 22 ;: 

110 110 11 27 9 27 31 28 

145 108 13 26 8 43 28 15 

217 36 28 10 9 63 11 12 

216 15 64 7 15 

189 2: 22 : ;; 20 

151 17 E 

172 

174 

;: 

29 :; 

1? 

7 

50 

55 1; 

$; 

21 

:; . . . 

. . . . . . 

,.. 16 30 .0. 

,.. 

29 

239 13 4 4 :; 4 17 

32

— — — — 

Table 9. Responses to questionnaire on revision of the Standard Certificate of Death, 1963—Con.


Class of respondent


Voluntary health Government University University All other


age~cy agency medical school other N=25
 N=41 N=32 N=22 N=55


Not Not Not Not Not Yes No stated Yes No stated Yes No stated Ye E No stated Yes No stated 

. — — 

7 21 16 13 9 11 lC 26 19 17 7 

7 21 ; 14 14 8 10 2L 15 16 13 8 

8 25 2 17 13 4 18 17 20 18 6 16 3 

9 14 5 20 5 5 19 29 5 4 16 

8 23 1 li 15 6 12 1$ 2; 12 7 11 7 f 

29 3 16 37 4


14 12 :; ;: 13 ; 27 1: ;; ;
 5 27 1 2? 10 7 13 6 34 15 1: 6


35 21 6 19 2 47 1 20 1 4


2: 1; 5 14 2; 5 16 4


1: 9 : 7 H 6 1 ;; 2 :; 2 7 16


14 16 12 8 12 10 10 27 10 18 9 8 8 

22 13 L7 9 6 19 2 26 13 16 5 17 3 

31 8 20 12 20 2 40 15 15 5 5 

27 20 2 10 1 45 9 14 

26 1: 23 1 41 : 11 ; ; 14 17 3 1! ; 7 H 14 4 7 

5: 12 1 :: 2 23 16 6


27 : 11 z 22 1 32 14 : 8


10 ... 7 ... ,.. ... 36 8 ,.. 12
 14 ... 6 ... 19 1; ... 1; ... ...
 34 3 21 1 10 21 38 17 2? 1 3
 — — —


33

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Table 10. Percent of State registrars and all other respondents favoring routine certificationof


items on Standard Certificate-ofDeath, 1963 -


Item


Education


Birthplace of parents


Was autopsy perfomed


Describe how injury occurred


Kind of business


Burial, cremation, removal


Cause of death


Date received by local registrar


Place of injury


Injury occurred (at work, not at work)---------------------------------------


City, town, location


Color or race----------------------------------------------------------------


Usual occupation


Was deceksed in U.S. Armed Forces


Name and age of spouse


Date--------


Name of cemetery or crematory


Citizen of what country


Location of burial


Accident, suicide, homicide


Birthplace


Father’s name----------------------------------------------------------------


Mother’s maiden name---------------------------------------------------------


Medical certificationstatement


Informantaddress


Funeral director address


Social SecurityNwber


Name of hospital


Address ................--------


Marital status


Date signed -


Signature


Usual residence..................---------.........---------.........-.--...-


Date of birth----------------


Age-------- -


Registrar’s si@ature-------------------------------------------------:------


County


Se~--------------------------------------------------------------------------


Date of death


Name of deceased


City, town, location (place of death)


Percent


36.0 26.1


39.3 29.0


56.8 44.2


59.5 34.3


61.0 54.4


61.4 42.1


61.4 42.1


61.9 40.0


61.9 40.0


61.9 39.4


62.8 43.1


63:6 48.8


65.1 57.1


70.5 59.2


71.4 41.5


71.4 63.2


72.1 60.9


72.7 64.1


73.2 43.6


73.2 43.6


75.0 62.2


75.0 62.0


75.0 61.5


76.7 51.3


77.3 63.0


81.4 64.2


81.8 76.7


82.9 84.7


83.7 77.2


84.1 67.7


88.4 78.3


88.4 79.0


88.6 87.6


88.6 85.3


93.2 85.9


95.3 73.4


97.5 97.5


100.0 98.2


100.0 98.8


100.0 98.8


100.0 98.8

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Table 11. Responses to questionnaire on revision of the Standard Certificate of Death, 1965


Class of respondent


Persons in Public
 State registrara Health Service
 N=34 (includeaN:~S staff)
 Item


Approved Apprrved Appreved 

No No No 

opinion opinion pinion Plan I Plan II Plan I Plan 11 Plan I Plan 11


Plan I vs. plan 11


Choice of using one
 certificate aa


opposed to the use of
 two certificatea------ 56 25 40 19 12 3 4 4 11


ADDITION Ap- Disap- No Ap- Diaap- No Ap- Disap- No 

prwed proved Dpinion proved proved @.rliOnprwed proved opinion 

Autopsy findings 

Were sutopsy findings used in determining 

the causes of death--- 82 6 33 27 2 5 10 1 8 

MODIFICATIONS


Race


To retain on certificate and drop words ‘IorcOIOrof 69 14 38 24 3 7 8 1 10 

To add the name and age of surviving spOuae--- 69 15 37 21 6 7 8 3 8 

Csuse of death


certification


Part 1. Add the worde
 auoras a consequence
 ofa!after the words
 “due toli-------------- 71 14 36 24 3 7 10 5 4


Psrt 2. Insert the
 word “spproximete” be-
 fore the words


‘tinterva
1 between onset and deathii 85 12 24 30 2 2 11 4 4 

Accident, suicide,


homicide


To have accident on
 physician’s cert.
 have “auicid& or hom­


icide” on mad. exam­


iner’a & coroner cert.
 add !Imannerundeter­
 mined’ on joint certs.- 46 23 52 8 9 6 1 12 

Funeral directoiT=‘­
 ‘signature


To require the funeral director’a signature-- 57 20 44 20 10 4 6 2 11 

DELETIONS


To delete “length of
 stay in city, town,
 or location where
 death occurred’’ 66 9 46 24 2 8 7 12


To delete “Ia residence on farm!’-------------- 72 3 46 25 9 11 

To delete a%eteran statua,,--------------- 62 14 20 8 6 11 
1 

lTable 11. Responses to questionnaire On revision Of the Standard Certificate of Death, 1965-Con.


Claas of respondent


Persona in State and
 Persons in all other loca1 health agenciea Social scientiata Other
 l?edera;=~ynciea (StQelJe:~;~ Officers) N=5 N=17


Approved Approved Approved Approved 

No No No No 

]pinion >inion )pinion opinion 

Plan I ‘lan II ‘lan I ‘lan 11 ‘lanI ‘lan 11 ?lan I Plan 11 

3 . 8 21 7 7 2 3 7 2 8 

Ap- M.aap- No AP- lisap- No AP- liaap- No Ap- disap- No 

proved >rwed >pinion moved moved >inion ,rwed moved >pinion ?roved proved opinion 

5 6 28 2 5 1 4 11 1 5 

. 

5 2 4 19 5 11 3 1 1 10 2 5 

7 . 4 20 6 9 3 2 10 7 

2 2 7 24 2 9 3 2 8 2 7


3 2 6 28 2 5 3 2 10 2 5 

L lC 16 10 9 1 4 6 3 8 

4 7 17 7 11 1 ,4 9 1 7 

3 1 7 20 5 10 3 2 9 1 7 

4 7 23 2 10 3 2 10 7 

5 . 6 18 4 13 3 2 10 7 
----------

------

--------------

-------------

-------------

------------

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----------------

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Table 12, Responses to questionnaire on revision of the Standard Certificate of Fetal Death, 1965


Class of respondent


Persons in Public


All respondents State registrars Health Service


Item N=109 N=33 (include:&S staff)


, 

Ap- Disap- No AF Disap- No Ap- )isap- No 

moved proved opinion p~oved proved opinion ]roved )roved opinion 

Additions


Hour of delivery 51 7 51 

T

16 3 14 5 lC 

Education of parents 45 26 38 12 11 10 5 1( 

Mother’s date of birth---- 41 21 h? 11 9 13 3 3 : 

Date of last live birth--- 47 18 44 a=14 9
 10 5 1(

Date of delivery of last 

fetal death 46 15 48 11 5 1( 

Month of pregnancy in


which prenatal care
 began-------------------- 48 10 51 13 5 15 3 2 lC 

Complications of pregnancy 

and delivery 43 20 46 13 7 13 3 3 s 

Congenital malformations or anomalies 45 15 49 z14 4 15 3 3 ~ 

Birth injuries 45 14 50 14 I 4 15 3 3 

‘Were autopsy findings


considered in deter-


mining causes of death?”- 32 1 76 10 1 22 3 12 

Name and address of the 

funeral home------------- 32 1 76 + 11 1 21 2 1: 

Deletions


“IS residence on a farm?”- 53 2 54 15 1 17 6 

“Father’s occupation and


kind of b:siness or
 industry. 49 3 57 12 2 19 5 1 

Name or signature of 

informant 34 74 11 1 21 2 

“Title” of authorized 

official 30 1 78 10 1 22 2 

Modifications


“Date last normal menses
 began” replaces %eeks


of gestation’’ 50 5 54 L5 2 16 1 1[ 

Provision for reporting 

birthweight in grams or in pounds and ounces 42 50 i 13 6 14 1 1( 

To drop “or color” to race


item and move race of


parents to “medical and


health” section of the


certificate 51 46 15 4 14 4 1 lC


Provision for a space to


right of item to,indicate


whether cause indicated was fetal or maternal---- 31 75 10 1 22 3 2 1( 

“Signature” of funeral 

director in place of 

!Iname!t 30 1 78 10 1 22 2 1: —. f 

38

Table 12. Responses to questionnaire on revision of the Standard Certificate of Fetal Death, 1965—Con.


I Class of respondent


Persons in all other Persons in State and Social scientists Other
 Federal agencies local hea+::5agencies N=4 N=14
 N=8


I I 

Ap- Disap- No Ap- Disap- No Ap- Disap- No Ap- Disap- No 

proved proved opinion proved proved opinion proved proved Dpinion proved proved opinion 

3 - 5 18 4 13 

6 - 2 12 14 9 

4 - 4 15 7 13 

4 - 4 16 8 11 

3 1 4 16 5 14 

4 - 4 18 3 14 

3 1 4 15 8 12 

3 1 4 16 6 13 

3 1 4 16 5 14 

3 5 9 - 26


3 - 5 9 26


4 - 4 19 16


4 - 4 19 16


2 - 6 11 24


2 6 9 26


—


4 - 4 18 2 15


3 - 5 14 9 12


5 1 2 18 4 13


2 -
 6 9 - 26


2 - 6 9 26


2 2 7- 7 

3 1 tt 7 1 6 

2 2 6 2 6 

2 2 6 1 7 

2 2 6! 11 7 

2 2


2 2 --R-t+ 

2 2 7 1 6


2 2 7 1 6


1 3 6 8 

1 3 

2 1 1 7- 7 

2 7 7 

1 3 * 7 7 

1 3 6 - 8 

2 2 7 - 7


2 2 6 1 7


3 1 6 2 6


1 3 

1 3 

39

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----------- ----------------------------

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------------ ---------------

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1 

Table 13. Responses to questionnaire on revision of the Standard Certificate of Marriage, 1963


1 I 

Class of respondent


I 

I 

All f=~~dents Registration )fficia1 health Social


Item autp=p y a~=y8y scientists Other


N=60 N-48
 t-­ . 1
 Not rYes No stated Yes 10 i Not Not NW 

stated fes No stated Yes No statec No 

— — 

County of Licensure (top lefton record) I 

_.’’ 131 7 39 28 21 11 20 1 7 48 4 35 13 

‘-Date of birth of bride and groom


Include on the Standard Record: I “Date of birth” only----------------- 80 ... ... 13 ... . . . 12 . . . . . . 29 . . . 26 ... ,., 

,,Dateof birth!!and “Age last 

birthday’’ 87 ... ... 27 ... . . . 14 . . . . . . 29 . . . 17 ... . . . 

No response 10 ... ... 1 ... . . . 2 . . . . . . 2 . . . ... 5 ... . . . 

Usua1 residence of bride and groom


Think that the items on usual residence
 should be reworded 98 32 47 22 14 5 17 6 37 6 17 22 19 

Favor the suggested changes (add street 

name and number; request “city, tom, 

or rural location’’) 85 20 72 15 10 16 11 14 37 6 17 22 1 25 

Think that adding item, “Is residence
 inside city limits,” would improve
 statistics 78 39 60 19 13 9 2.7 t 7 30 9 21 12 1: 23 

Marital status of bride and groom
 I Favor wording:
 ,,Nwber of this marriage:


� lfirst 

•=dgp~~fi~


—


If remarriage,last marriage ended by:


� Death 

� Divorce or .nnUIMHIt 

Year of first marriage_’’ 130 29 18 25 14 2 20 f 2 50 3 7 35 6 7 

color or race of bride and groom 

Favor deleting item entirely 6 . . . ... 1 ... . . . . . . . . . 2 . . . . . . 3 . . . . . . 

Favor placing item in portion of record where acceas would be restricted (in some cases) 58 . . . ... 7 ... . . . 7 . . . . . . 25 . . . . . . 19 . . . . . . 

Favor leaving item in nonrestricted 

portion of record; retain item (as is) 69 . . . ... 19 ... . . . 13 . . 22 . . . 15 . . . ,.. 

‘0 ‘espouse I 44 . . . ... 14 ... . . . 8 . . . . . 11 . . . 11 . . . . . . 

Favor wording: I


color or race------------------------ 47 . . . ... 14 ,., . . . . . . 14 . . . ... 12 .0, . . . 

race (only) 57 . . . ... 13 ... . . . . . . ... 23 . . . ... 12 . . . ,.. 

color (only)------------------------- 6 . . . !.. 2 ... . . . . . . ... . . . ... . . . ,,. 

other wordings 7 . . . ... ... . . . . . . ... i . . . ... ; . . . .,. 

Favor deleting item entirely 6 . . . ... ... . . . . . . .. . . . .. . . . . . . . 

No response 54 . . . ... 1: ... . . . . . ... 1; . . . .. . 1; . . . . . . 

Occupation and industrv of
 bride and groom
 1


Approve including the item, “Education: years of school completed’’ 125 31 21 1$ 16 6 ( 3 5; 1 2 30 [ 10 

If favorable to including this item, would use it as: 

substitute for occupation addition to occupation 

No response 

;; 

5? 

. . . 

. . . 

. . . 

... ... 

... 

$ 

;: 

... ... 

... 

. . . 

. . . 

. . . 

..4 

. . . 

..! 

... 

... 

... ;; 

1 

. . . 

. . . 

. . . 

... 

... ... 2; 

18 

. . . 

. . . 

. . . 

. . . 

. . . 

. . . 

d

Religiousvs civil marriage ceremonies


65 lC 27 4 11 3f 12 2e 12 

24 l?i 18 9 14 / 1: i 4 i: 1 4: 

— — — — — — — — — 

40 
--------------------------------------------------------------------

-----------------------------------------------

-------------------------------------------------------

---------------------------------------------

------------------------------------------------------

-----------------------------------------------------

-------------------------------------------------------

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------------------------------------------------------------

-------------------------------------------------------------

----------------------------------------------------------------

----------------------------------------------------------------

Table 14..Percent of State registrars and all other respondents favoring routine certificationof


item; on Standard Certificateof Marriage, 1963


Item


Education


Religious vs. civil ceremonies


Number of previous marriages (bride)-----------------------------------------


Number of previous marriages (groom)-----------------------------------------


Usual occupation (bride)-----------------------------------------------------


Kind of business or industry (bride)-----------------------------------------


Kind of business or industry (groom)-----------------------------------------


Usual occupation (groom)-----------------------------------------------------


Previous marita1 status (bride)----------------------------------------------


Previous marita1 status (groom)----------------------------------------------


Color or race (bride) -


Color or race (groom)--------------------------------------------------------


I 

Date of signaturesof applicants


Date of birth (bride)--------------------------------------------------------


Date of birth (groom)
 -


Place of birth (bride)-------------------------------------------------------


Usua1 residence (bride)------------------------------------------------------


Place of birth (groom)-------------------------------------------------------


Usual residence (groom)------------------------------------------------------


Maiden name if different


Official making retwn


Date of recording


Place of wrriage


Date of marriage


Name of bride


Name of groom


Percent


18.2 32.3


40.7 30.0


41.9 34.1


41.9 35.7


44.8 53.0


46.7 51.2


46.7 48.1


48.4 50.0


53.1 41.9


53.1 42.4


57.6 26.1


57.6 26.4


76.7 86.1


78.8 84.9


78.8 84.9


84.8 62.8


84.8 84.9


84.8 61.2


84.8 86.0


93.5 78.8


96.9 85.2


97.0 86.6


97.0 91.5


97.0 94.0


100.0 97.7


100.0 100.0


41

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--------------------

-----------------

--------------------

--------

-----------------

----------------------

Table 15. Responses to questionnaire on revision of the Standard Certificate of Marriage, 1965


i 

All respondents


Item N=91


Ap - Disap - No
 proved proved opinion


Class of respondent


I Persons in Public I State registrars Health Service 

Additions


Local file number ---------


Date license issued


Name and birth places of


parents of bride and


groom


Signature of officiant,


date and specification


of position of officiant


as clergyman or civil


officer ------------------


Education (years of


school completed)--------


Modifications


License issued (county)---


Residence


Street and number or


R.F.D


Information about


previous marriage


Signature of applicant(s)


and date


Date received by local


official -----------------


Race 

Deletions


Usual occupation and kind


of business or industry


of bride and of groom----


10 1 80


11 1 79


40 14 37


44 7 40


47 22 22


12 1 78


10 8 73


11 2 78


46 9 36


13 4 74


10 2 79


44 14 33


44 11 36


Ap ­


proved


8


8


10 

15


13


8


5


6


15


7


6


13


17


N=28 (includinfi=CHS staff)


I — —-l----1 

Disap- No Ap - Disap- No


proved opinion proved proved opinion


T1 19 

1 19 

10 8


+	 5 8 

10 5

7 20 

4 19


1 21


4 9


4 17


2 20


6 9


4 7


+ 

1 I 

1 

1 

1 

4


1 

1 

2


5


1 

1 

3


3


7 
--

Table 15. Response to questionnaire on revision of the Standard Certificate of Marriage, 1965—Con.


Class of respondent


Persons in all other


Federal a!zencies


N=8-


Ap - Disap- No 

Persons in State and


local health agencies


(includinz State


HealthNO;~cers)
 .


Ap - Disap- No 

Social scientists Other


N=6 N=ll


I 

Ap - Disap- No Ap - Disap- No 

proved proved opinion proved proved opinion 

6 11 

6 1 - 10 

1 6 - 5


-4-= 3 6 - 5


4 2 6 5


6 1 10 

6 1 10 

6 1 10 

3 - 3 5 - 6


6 11 

6 11 

3 2 1 5 - 6 

3 1 2 4 - 7


~roved proved opinion proved proved opinion


+ 8 1 29 I 

8 1 29 

I

5- 3 13 2 15


5- 3 14 1 15


5 - 3 15 8 7


- 8 3 27


1 - 7 3 3 24


- 8 3 27


5 - 3 13 5 12


- 8 25


,- 8 3 . 27 

5 - 3 15 5 

,, 

5 - 3 12 6 12


43

-----------------

--------------------------

----------------

------------

----------------------

-----------------------

---

-----------------------

--------------------------

-------

----------------------------

-----------------------

---------------------

--------

------------

Table 16. Responses to .auestionna.ire on revision of the Standard Certificate of Absolute Divorce or Annulment, 1963


Class of respondent


All respondents Registration )fficial health Social
 Other
 authority agency scientists Item N=169
 N-45
 N=3S N=26 N=60


— — 

Not Not Not Not fes [0 stated Yes 10 ;tated ?es ~o ~~;ed Yes No stated fes 10 tated c .

Date of birth of husband and wife


Reword to “Date of birth and age in 

years, last birthday ’’ 81 .. . .. . . ... 13 ,.. ... 31 ... ... 16 . . ... “Date of birth Onlyqv----------------- 77 .. ... :: . . .. . 11 ... .. . 26 ... ... 24 ,. ... No response 11 .. ... 1 . . ... 2 ... .. . 3 ... ... 5 . . ... 

Usual residence of husband and wife


Should item be reworded 96 33 ~ 40 13 5 14 6 6 38 5 17 24 9 12 

Favor the suggested changes 74 14 81 :$’ 4 19 11 2 13 I 30 5 25 18 3 24 

Item “Is residence inside city limits” 

would be help ful 74 49 46 15 16 7 15 29 12 19 15 16 14 

Number of this marriage of


~sband and wife


It would be desirable that these items


be expanded to include the reason


for dissolution 135 18 24 12 2 22 6 35 7


Do you favor the suggested x-ewording 100 21 :: 19 6 13 13 : d 12 28 : 13 

Color or race of husband and wife


These items should be retained cm the 

Standard Record 133 30 8 23 . . . 3 53 . 27 14 

The words “color or” should be omitted- 47 6: 54 :: i? 12 9 10 7 18 Zf 1; 7 2; 18 

The items should be relocated to a 

restricted po..tion of the record ------ 44 71 54 6 20 12 7 10 9 20 23 17 11 18 16 

Occum. tion and industry of


husband and wife


‘&::t:~n~cludin8 the item, years of school completed”- L21 26 22 19 15 4 17 4 5 57 ,.. 3 28 7 10 

Favor substituting “education’m for
 !,Occu atlon .. .. . 9 .. .. . 6 ... .. . ,.. ... 6 .. ... Fa”or Eed:ca:ion,, as an addition :: .. ... 10 . . ... 13 ,.. ... :: ,.. ... 21 .. ... 

No response 48 .. ... 19 .. ... 7 .. . .. . 4 ,.. .. . 18 .. ... 

Number of children under 18 I I 

Favor adding to this item age and


sex of child ren 99 43 27 6 23 9 12 9 5 47 6 7 34 5 6


Favor addin8 age and sex, but in a


differe”c wording 28 21 120 9 16 13 5 3 18 9 ... 51 5 2 38


Date and place of final separation


Favor the addition of the itemh “Date


and place of final separation 119 19 17 12 9 19 3 4 49 2 9 34 9


Favor the suggested wording 102 19 :: 15 4 19 17 2 7 42 8 10 28 : 12


Name and address of attorney


for plaintiff
 I Favor the addition of the item, “Name


and address of attorney ’’-------------- 112 15 42 31 2 5 171 1 8 35 4 21 29 8 8 

— 

44 
--------------------------------------------------------------------

-------------------------------------------

--------------------------------------

-----------------------------------------------------

-------------------------------------------------------

--------------------------------------------------------

--------------------------------------------------------------------

------------------------------------------------------------

-----------------------------------------

-------------------------------------------

--------------------------------------------------------------

Table 17. Percent of State registrars and all other respondents favoring routine certificationof


items on Standard Certificate of Absolute Divorce or Annulment, 1963


I 

Item


Education


Date and place of final separation


Usual occupation (husband)---------------------------------------------------


Kind of business or industry (husband)---------------------------------------


Usual occupation (wife)------------------------------------------------------


Kind of business or industry (wife)------------------------------------------


Number of this marriage (husband)--------------------------------------------


Name, addresa of attorney for plaintiff


Number of this marriage (wife)-----------------------------------------------


Color or race (wife)---------------------------------------------------------


Color or race (husband)------------------------------------------------------


Number of children under l8--------------------------------------------------


Legal grounda for decree


Place of birth (huaband)-----------------------------------------------------


Place of birth (wife)--------------------------------------------------------


Date of birth (husband)------------------------------------------------------


Date of birth (wife)---------------------------------------------------------


Place of this marriage


Date of this marriage


Usual residence (wife)-------------------------------------------------------


Usual residence (husband)----------------------------------------------------


Plaintiff


Decree granted (to husband, wife)--------------------------------------------


Date of recording


Statement certifyingdate of divorce


Signature, title of court official


Maiden name of wife----------------------------------------------------------


Name of husband


Percent


10.0 30.8


36.4 39.2


46.2 48.1


46.2 45.6


46.2 47.5


46.2 45.0


46.4 34.9


48.0 42.3


48.1 31.3


59.3 22.6


59.3 2L.7


59.3 51.9


67.9 47.4


67.9 56.6


70.4 56.6


70.4 79.5


74.1 56.6


75.0 81.9


78.6 84.3


78.6 85.4


79.4 85.4


89.3 55.6


89.3 59.0


92.9 86.4


96.6 88.9


100.0 88.8


100.0 89.2


100.0 97.6


45

-----

----------------

------

--------------------

------------

-----------------

-------------

Table 18. Responses to questionnaire on revision of the Standard Certificate of Divorce or Annul-


ment, 1965


Class of respondent I 

Persons in Public


All respondents State registrars Health Service


Item N=87 N=2.5 (include:=&CHSstaff)


Ap- lisap- No Ap- disap- No Ap- Disap- No 

proved }roved Dpinion proved proved >pinion proved proved opinion 

1 

Additions


Date couple separated 43 7 37 14 3 8 5 4 

Name and address of the 

attorney for the 

plaintiff 51 2 34 19 1 5 4 5 

Name of the court where


divorce was granted 45 3 39 16 2 7 4 5


Education of husband 

and wife----------------- 45 10 32 12 6 7 5 1 3 

How previous marriage


ended 42 7 38 14 3 8 4 5


Modifications


Title - Absolute divorce 

and annulment 44 1 42 19 6 3 6 

Number of living 

children 49 2 36 17 1 7 3 6 

Race---------------------- 48 9 30 16 3 6 3 1 5 

Major change in the formats of the 

certificates 38 10 39 10 8 7 4 5 

Deletions


Usual occupation and kind


of business or industry


of husband and wife------ 45 5 37 15 2 8 5 4


46

Table 18. Responses to questionnaire on revision of the Standard certificate of Divorce or Annul­


ment, 1965—Con.


Class of respondent


I Persons in State and


Persona in all other local health agencies Social scientists Other
 Federa~=;ancies (including State


Health Officers) N=6 N=9


N=28


Ap- )isap- No Ap- Disap- No Ap- )isap- No Ap- Disapproved proved opinion proved proved opinion proved moved opinion proved proved opinion 

4 1 5 12 3 13 4 2 4 5 

2 1 7 11 5 1 4 5 

4 6 14 1 13 3 3 4 5 

5 5 13 3 12 6 4 5


5 5 11 3 14 4 1 1 4 5 

3 7 13 1 14 3 3 3 6 

4 5 16 12 5 1 4 5 

7 3 14 3 11 3 2 1 5 4 

4 6 13 1 4 1 1 3 6 

5 5 13 2 13 4 1 1 3 6 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public Health Service Publi~atian No. 1000 

Seyies 1.	 PvogYams and collection p?’oceduyes .—Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, 

and other material necessary for understanding the data. 

SeYies 2.	 Data evaluation and methods veseaych. — Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

Sevies 3. Analytical studies. —Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of re~rts in the other series. 

Series 4. Documents and committee Yepoyts. — Final reports of major committees concerned with vital and 

health statistics, and documents such as recommended model vital registration laws and revised birth 

and death certificates. 

Series 10.	 Data fyom the Health Interview Survey. —Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected 

in a continuing national household interview survey. 

SeYies 11. Data fyom the Health Examination Survey. — Data from direct examination, testing, and measurement of national samples of the ppulation provide the basis for two types of reports: (1) estimates€

of the medically defined prevalence of specific diseases in the United States and the distributions of€

the population with respect to physical, physiological, and psychological characteristics; and (2)€

.	 analysis of relationships among the various measurements without reference to an explicit finite 

universe of persons. 

SeYies 12.	 Data fyom the Institutional Population SuYveys.— Statistics relating to the health characteristics of 

persons in institutions, and on medical, nursing, and personal care received, based on national 

samples of establishments providing these services and samples of the residents or patients. 

SeYies 13.	 Data from the Hospital Dischavge Survey. —Statistics relating to discharged patients in short-stay 

hospitals, based on a sample of patient records in a national sample of hospitals. 

SeYies 20.	 Data on mortality. —Various statistics on mortality other than as included in annual or monthly 

reports —special analyses by cause of death, age, and other demographic variables, also geographic 

and time series analyses. 

SeYies 21.	 Data on natality, rnan-iage, and divoyce. —Various statistics on natality, marriage, and divorce other 

than as included in annual ~r monthly reports —special analyses by demographic variables, also 

geographic and time series analyses, studies of fertility. 

SeVies 22.	 Data fyom the National Natality and MoYtality Swveys. —Statistics on characteristics of births and 

deaths not available from the vital records, based on sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, ”etc”. 

For a list of titles of reports published in these series, write to: Office of Information€

National Center for Health Statistics€

U.S. Public Health Service€

Washington, D.C. 20201€