0938 0581 2010 form-2025

1. Click ‘Get Form’ to open the 0938 0581 2010 form in the editor.
2. Begin by filling out the General Information section. Indicate whether this is an Initial Application, Survey, or Change in Certification Type. Leave the CLIA Identification Number blank if this is your first application.
3. Provide your Facility Name, Federal Tax Identification Number, Email Address, and Telephone Number. Ensure that the Facility Address is accurate as it will be used for mailing purposes.
4. In the Type of Certificate Requested section, check only one box that corresponds to your laboratory's needs (e.g., Certificate of Waiver).
5. Complete the Type of Laboratory section by selecting the option that best describes your facility type.
6. Fill in the Hours of Laboratory Testing section using HH:MM format for each day of the week.
7. If applicable, indicate if you are applying for multiple site exceptions and provide necessary details about each site.
8. Identify any waived testing performed and provide estimated annual test volumes in their respective sections.
9. Review all sections carefully to ensure completeness before submitting your application through our platform.

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