​ How to Submit a Multiple Site License Application

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 H. Review Secondary Site Information

This screen will let you review all the Secondary Sites information by clicking the caret next to the testing site. Review and click Edit if necessary. Click Next to confirm the information and proceed.

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 I. Upload Documents

Prepare forms and upload it on this page:

• LAB 182 (pdf) (Owner Attestation) - with signature by the Laboratory Owner or Authorized Representative
• LAB 183 (pdf) (Director Attestation) – with signature by the Laboratory Director
• CMS 116 (pdf) (CLIA Application for Certification) – completed and signed

Click Next.

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 J. Payment Information Summary

The system will show you the application fees due. Click Next to proceed.

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 K. Sign Attestation

Read the Application Attestation. Using your mouse, sign if you accept.

Click Accept.

Click Submit.

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 L. Pay and Submit Application

Click the Shopping Cart button.

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Make sure the Primary Site is selected, then, click Proceed to Checkout.

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Select your payment method.

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Fill in the required payment and billing information.

Select the checkbox to authorize payment.

Finally, click the Submit button to submit your application for review.

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A receipt will also be emailed. Click Close.

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