Forms

• CLIA License Application CMS-116 and instructions (CMS) - PDF
• Complaint Form and Instructions - PDF (PDF without form fields)
• Tissue and Sperm Bank Registration - PDF

CLIA Certificate-Change Requests

• Making Changes to your CLIA Certificate
• Certificate Type Change - PDF
• Disclosure of CLIA Certificate Shared Lab - PDF
• Disclosure or Change of Ownership and Tax ID - PDF
• Laboratory Name, Address and Director Change - PDF
• Specialty, Subspecialty and Test/Assay Change - PDF