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Minnesota Paid Leave Verification of Birth Form

Parents applying for Minnesota Paid Leave bonding leave can use this optional form to certify that their child was born. The provider gives the child's name, or baby girl or baby boy if not yet named, the date of birth, and whether the child needs to stay in the hospital longer than the birthing parent, with an expected discharge date. It cannot certify medical leave.

Who completes it

The birthing parent, the non-birthing parent, or both, complete their own sections if they are applying for leave and sign. The treating provider completes Section 3 (birth information) and Section 4 (provider certification) and returns the form.

Submitting and payment

How to submit it
The applicant uploads the completed file, or photos or a scan of a printed copy, at paidleave.mn.gov with the bonding leave application; the provider may also fax it to Paid Leave.

Good to know

  • The form is optional. Paid Leave also accepts signed hospital discharge paperwork, a letter from a medical provider, or a birth certificate as proof that the child was born.
  • By signing, the provider certifies the applicant welcomed a child into their home by birth and is a parent of the child listed. A license or practice number is required.
  • Recovery from birth is medical leave, certified on the Medical Leave or Pregnancy-related Medical Leave form, not on this form.
  • Proof of a birth outside the United States can take 8 to 12 weeks to verify; Paid Leave says a U.S. provider can complete this form to speed up review.

Get the official form

Download the current version from the source each time; forms change without notice.

Minnesota Paid Leave Verification of Birth Certification Form

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Is the Minnesota Verification of Birth form required for bonding leave?

No. It is one of several ways to show the child was born. Minnesota Paid Leave also accepts signed hospital discharge paperwork, a letter from a medical provider or a birth certificate. Parents who choose this form submit it with their bonding leave application after the provider completes the birth information and signs.

Can both parents use one Verification of Birth form?

Yes. The form has a section for the birthing parent and a section for the non-birthing parent, and each completes their section only if they will apply for Paid Leave. The provider then completes one birth information section and one certification for the child.

Who can sign the Minnesota Verification of Birth form?

A healthcare provider licensed, certified or otherwise authorized to certify the birth within their scope of practice. The form names an OB-GYN, midwife, nurse practitioner or primary care physician as typical choices, and the provider must enter a license or practice number for the form to be accepted.