Permission to Procure Birth Control: U.S. Government Form BC-451

By Tara Campbell

U.S. Government Form BC-451: Permission to Procure Birth Control

In accordance with the Maternal Priority Act of 2020, any and all requests for contraception must be approved by the U.S. Department of Health and Fetal Services. To that end, please complete the following questionnaire:

Name of Infernal Harlot (Last, First): _________________________________________

Citizenship status

1. U.S. Citizen
2. Naturalized U.S. Citizen*
3. Dual Citizen*
4. Permanent Resident*
5. Spanish-speaker*
6. Olive-skinned*
7. Otherwise suspicious*

* This is the incorrect form for your use. Please submit Form 4827: Voluntary Forfeiture of Citizenship Status and Form 3453: Requisition for Repatriation to Country of Ancestral Origin.

Race/Ethnicity

1. Caucasian or White
2. African American or Black*
3. Asian*
4. Native Hawaiian or Other Pacific Islander*
5. American Indian or Alaska Native*
6. More than one*

* This is the incorrect form for your use. Please submit Form 3453 Requisition for Repatriation to Country of Ancestral Origin. Alternatively, submit Form 3423, Requisition for Federally-Funded Sterilization.

I, Infernal Harlot (First name, Last name) ___________________________________________, am requesting permission to procure birth control for the following reason(s); check all that apply:

1. __ I choose not to have children at this time.
   Please report for six-month Re-Acculturation Training for self and husband. Be advised, failure to do so will result in a filing with your state’s attorney general.
2. __ My family cannot afford to have additional children at this time.
   Please be advised that per the Find A Way Act of 2020, the right of the child to be conceived supersedes any and all other potential concerns, such as present ability to feed, clothe, house, or protect current or future children. Potential parents are legally bound to procure such means should conception occur, and as such, all petitions for birth control lodged upon this basis will be rejected.
3. __ Bearing a child will disrupt completion of school/my ability to work.
   Per the 2021 Patriot Mother Act, an approved and notarized Form 1426b: Justification for Continuance of Educational/Professional activities must be attached. Please note that applications filed under this justification will be investigated and may result in termination/expulsion from your educational program.
4. __ Health risks associated with pregnancy.
   Per the 2022 Valiant Vessel Act, you must attach a statement from your pastor attesting that the benefit to the world of any potential child that might have been conceived was considered coequally with the value of its mother’s survival. Please note, physicians’ statements are no longer considered valid.
5. __ I’m too young to have children.
   Please consult the 2023 Budding Young Future Act, which revised age of consent with parental or assaulter’s permission, and harmonized it with appropriate childbearing age on a national level.
6. __ To regulate my periods.
   Attach a statement from your husband along with form HOLI-1: Certification of Training: Understanding God’s Plan for You. Please note, physicians’ statements are no longer considered valid.
7. __ Treatment for ovarian cysts, endometriosis, or other health conditions unrelated to pregnancy prevention.
   Attach statements from your husband and your pastor, along with form HOLI-1: Certification of Training: Understanding God’s Plan for You. Please note, physicians’ statements are no longer considered valid.
8. __ Risk of sexual assault.
   Attach proof of address; most recent crime report from your precinct, certified by a reliable male law enforcement official; notarized letters from any potential assailants granting you their permission to not bear their children; and form HOLI-1: Certification of Training: Understanding God’s Plan for You.
9. __ I am dating a married CEO or Member of Congress.
   Attach copy of text messages and current mailing address for immediate shipment of contraceptives.

IMPORTANT NOTE: All petitions based on reasons 1 through 8 will be rejected per the Fetal Host Act of 2024.

________________________________________________________________________
Name and Social Security Number of Infernal Harlot (print)

________________________________________________    ______________________
Signature of responsible party                           Date

________________________________________________
Relationship to Infernal Harlot (Husband/Father/GOP Elected Representative)

By signing this form, you acknowledge that you have given your wife/daughter/mistress permission to procure birth control, which may render your household subject to additional surveillance. Please be advised that per the Purity of Penetration Act of 2020, all carnal activity, including that between husband and wife, but with the exception noted in point 9 above, is purely for purposes of procreation. Anyone who knowingly commits fornication (sexual contact for purposes other than procreation, with the exception of point 9 above) may be subject to prosecution under federal law, potentially resulting in fines and/or jail time, and forfeiture of present and/or future rights to erectile dysfunction therapy.

Tara Campbell (www.taracampbell.com) is a writer, teacher, Kimbilio Fellow, and fiction editor at Barrelhouse. Prior publication credits include SmokeLong Quarterly, Masters Review, Jellyfish Review, Booth, and Strange Horizons. She’s the author of a novel, TreeVolution, a hybrid fiction/poetry collection; Circe’s Bicycle, and a short story collection, Midnight at the Organporium. She received her MFA from American University in 2019.

Photo by Matthew Henry on Unsplash.