CH-175

Cover Sheet for Confidential 
Information

CONFIDENTIAL

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 
copies) you want to file, and file them with the court.

Parties in This Case
a.

Person who filed the case:
(Name):

b. Other party or parties:

(Name):

1

2

Information About the Order for Confidentiality
a.

The order was made in (check one):
(1)
(2)

This case.
Another civil case:
Case number:
County it was filed in:
Attach a copy of the order (form CH-165) if you have one.

(a)
(b)

b.

Minor protected by confidentiality order:
(1)
(2)

Name:
Name:

Check here if you need more space. Include the information 
on a separate piece of paper, write “Attachment 2” on the 
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:

Fill in court name and street address:

Superior Court of California, County of

Fill in the case number:

Case Number:

Instructions to Clerk 
1.  The court must review and 

approve a redacted version of 
documents attached to this cover 
sheet before filing. 

2.  Once approved by the court, file 
the redacted version in a public 
file. 

3.  File the unredacted version and 
this cover sheet in a confidential 
file. 

Type or print your name

Check here if you are a lawyer.

Sign your name

Judicial Council of California, www.courts.ca.gov  
Rev. September 1, 2020, Mandatory Form 
Code of Civil Procedure, § 527.6(v)

Cover Sheet for Confidential Information 
(Civil Harassment Prevention)

CH-175, Page 1 of 1