Form Requirements:
-
LAB 144B -
Application for Additional Testing Site
-
LAB 155R -
Application for Renewal Registration
(for CLR, CDR, CLP, CDP, CNC, CEW, CEP)
-
LAB 144R -
Application for Renewal License
(for CLF, CDF, CLA, CDA, CLM, CEA, CEC)
-
LAB 183 -
Director Attestation
-
CMS 116 -
to update CLIA certificate
- Fee required:
$28 per new secondary site.
See Fee Schedule
- No Fee required for these State ID types:
CEW, CEP, CEA, CEC
We will contact you by email if additional information is required upon review. It is important that you include a valid
email address on each form to avoid delay. See "Send Application To" below.
Basic changes such as address, phone, fax, email, laboratory name (without ownership change), certificate corrections, and closure of business, upgrade or downgrade (initial fee required), require these forms:
-
LAB 193 -
Notification of Laboratory Change
-
LAB 183 -
Director Attestation
-
CMS 116 -
to update CLIA certificate
We will then contact you by email if additional information is required upon review. An initial fee is required for a downgrade or upgrade. It is important that you include a valid
email address on each form to avoid delay. See "Send Application To" below.
All facilities with State ID that starts with
CNC
(e.g.: CNC-333333) require review of exempt status. To know if you are truly exempt,
please read this carefully.
For
any change, submit these forms:
-
LAB 155 -
Application for Initial Registration
-
LAB 193 -
Notification of Laboratory Change
-
LAB 183 -
Director Attestation
-
CMS 116 -
to update CLIA certificate
We will contact you by email if additional information is required upon review. An
initial fee may be required if exempt status no longer applies. It is important that you include a valid
email address on each form to avoid delay. See "Send Application To" below.