× The federal government has shut down due to the failures of the President and Congress to continue government funding. Millions of Californians receiving benefits from state programs may be impacted. For now, California’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) will continue to provide services and enroll eligible families as long as funding is available. No new federal funding to California WIC will be provided until the President and Congress take action. Families should continue to use their WIC benefits and attend their WIC appointments. This information is subject to change, so please monitor the California WIC website for updates.

Please be wary of potential highly partisan political messaging while visiting federal government websites for information related to the federal government shutdown.

Home
Programs
Office of the State Public Health Laboratory Director
Laboratory Field Services
ELLFS - Renew Single Site Application - Page 2

LABORATORY FIELD SERVICES

Renew Single Site License (User Manual)

step 13 Review and update the information if necessary. Click Next.

Please note:

If Waived or PPMP, uploading LAB 144A and adding tests are not required.
If Moderate or High Complexity, either:

select tests using the dropdown options (skip adding Waived tests),
-OR- upload a LAB 144A.pdf form.

Tests Performed screen showing Analytes added

step 14 Laboratory Personnel section: A CLIA laboratory director must be added to move forward. A Role must be assigned to each record. Click Submit.

To edit: click the Edit icon.
To add: click Add New Laboratory Director or Add From Existing Personnel.
To remove or disassociate: click the Trash Bin icon.

Please note:

If Waived, uploading LAB 116 is not required.
If PPMP or Moderate or High Complexity, upload a completed LAB 116.pdf form.

Laboratory Personnel screen showing Laboratory Director, and uploaded LAB 116 form.

step 15 Click Continue Application.

Continue Application button to proceed with the renewal application.

step 16 Review and scroll down. Click the Next button.

Testing Site Information page showing arrow down to scroll down to click Next.

Associate Sites

step 17 Read the instructions. Select No, and click Next.

Associate Site screen showing No is selected.

Upload Documents

step 18 Read the instructions and upload the required forms. Upload CMS 116.pdf form if there are changes in your site. Click Next.

Upload documents screen showing uploaded required forms.

Application Summary

step 19 Review the Application Summary. You may click the Back button if you need to correct the information, otherwise, click Next.

Application Summary showing Annual Test Volume, Fee, and Payment information.

Application Attestation

step 20 Read the Application Attestation. Sign, click Accept, then click Submit.

Application Attestation page to write your signature.

Payment

step 21 Click Shopping Cart to proceed.

Page showing Shopping Cart button.

step 22 Select the items you want to pay, then click Proceed to Checkout.

Page showing items you could select in your Shopping Cart to include in the payment.

step 23 Enter Payment Details. Check the payment authorization clause. Click Submit.

Checkout screen to emphasize the payment authorization checkbox and email address.

step 24 Your application will be in Pending-RenewalReview status if you made major changes. If there are no changes, the system will approve your renewal application.

Business dashboard showing the updated status of the renewal application.

Page Last Updated :