Cover Sheet for Confidential CONFIDENTIAL

CH-175 Information
Clerk stamps date here when form is filed.

Instructions
Use this cover sheet:
When information about a minor has been made confidential (granted on
form CH-165, Order on Request to Keep Minor's Information Confidential,
and you want to file a document or form that includes confidential
information (see form CH-165, item 7).

How to use this cover sheet

Make two copies of the documents you want to file.
Complete this form, place it on top of the documents (both Fill in court name and street address:

copies) you want to file, and file them with the court. Superior Court of California, County of

1 Parties in This Case

a. Person who filed the case:
(Name):
b. Other party or parties:
Fill in the case number:
(Name):
Case Number:
2 Information About the Order for Confidentiality
a. The order was made in (check one):
Instructions to Clerk
(1) This case.
1. The court must review and
(2) Another civil case:
approve a redacted version of
(a) Case number:
documents attached to this cover
(b) County it was filed in: sheet before filing.
Attach a copy of the order (form CH-165) if you have one. 2. Once approved by the court, file
b. Minor protected by confidentiality order: the redacted version in a public
(1) Name: file.
(2) Name: 3. File the unredacted version and
Check here if you need more space. Include the information this cover sheet in a confidential
on a separate piece of paper, write “Attachment 2” on the file.
top, and attach it to this form.

3 I have attached two copies of the following documents:

Form CH-

Other form or document (describe):

4 Signature
Date:

Type or print your name Sign your name

Check here if you are a lawyer.
Judicial Council of California, www.courts.ca.gov Cover Sheet for Confidential Information CH-175, Page 1 of 1
Rev. September 1, 2020, Mandatory Form
Code of Civil Procedure, § 527.6(v) (Civil Harassment Prevention)
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