Fastener Quality Act Requirements

Attachment 2
Information Declaration to be completed by Laboratory Accreditation Body
OMB Number: 0693-0015
Approval Expires:
U.S. DEPARTMENT OF COMMERCE
NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY
FASTENER QUALITY ACT
Notwithstanding any other provision of the Act, no person is required to respond to, nor shall any person be subject
to a penalty for failure to comply with, a collection-of-information subject to the requirements of the Paperwork
Reduction Act, unless that collection of information displays a currently valid Office of Management and Budget
(OMB) Control Number.
The reason for collecting this information is to seek information from persons self-declaring that they meet the
requirements of ISO/IEC 17011 for laboratory accreditors and for quality system registrar accreditors. An organization
having made such an affirmation to NIST may accredit either fastener testing laboratories or quality system registrars
for fastener manufacturers in accordance with the applicable provisions of the Fastener Quality Act. No confidentiality
for the information submitted is promised or provided.
The public reporting burden per respondent for the collection of information contained in this rule is estimated to
average 1.5 hours. This estimate includes the time for reviewing instructions, searching existing information,
gathering and maintaining the information needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden to Office of Information and Regulatory Affairs, Office of Management and
Budget, Washington, D.C. 20503; and to National Institute of Standards and Technology, 100 Bureau Dr. Mail Stop
2600, Gaithersburg, MD 20899-2600.
This information can be placed on the information declaration, in the instructions for a collection, or in a cover letter
or memo that accompanies the collection of information. We usually recommend the information declaration itself
but you may feel otherwise.

INFORMATION DECLARATION INSTRUCTIONS

1.

Print or type all information. If more space is needed for a response use additional
sheets and reference the question being answered.

2.

Respond to all applicable questions fully. If not applicable write N/A.

3.

Any provided information that is considered proprietary or confidential should be
clearly indicated as such.

4.

All information must be completed in English.

5.

Send all completed information declarations to:
FQA Document Certification
National Institute of Standards and Technology
100 Bureau Drive, Mail Stop 2600
Gaithersburg, MD 20899-2600

For assistance call 301-975-4011 or Fax 301-926-0647

OMB Number: 0693-0015
Approval Expires:
INFORMATION DECLARATION
FOR A FASTENER LABORATORY ACCREDITATION PROGRAM
UNDER THE FASTENER QUALITY ACT
1.

Legal Name of Accreditation Body:

2.

Authorized Representative:
The Authorized Representative is the person who assumes all responsibility to commit the
organization to the terms of the agreement with NIST. This person will be NIST’s point of
contact with the organization. All correspondence with the organization will be addressed
to this person.
Printed Name
Title
Address
Street
(Mailstop, P.O.)
City

State

Zip

Country
Telephone
3.

FAX

Will all accreditation activities be conducted at the above address?
Yes

at another location(s)?

Please describe and give location of all sites to be included.

Laboratory Accreditation Body
Declaration:
As the Authorized Representative of the organization, by signing this document, I hereby declare and
commit to the following:
I have read the provisions of the Fastener Quality Act, as amended by P.L. 106-34 and fully understand
the requirements and the responsibilities imposed upon this organization.
I affirm that this organization fully meets the requirements of ISO/IEC 17011 (or another document
approved by the Director 1) and shall continue to meet such requirements. I will notify the NIST Director
if and when this organization no longer meets such requirements.
I understand that neither the accreditation body nor any accredited laboratory nor any other person or
organization may state or imply any product approval, certification or other type of recognition by NIST
or the U.S. Government solely because a fastener product was tested by a laboratory accredited by this
organization.
I will ensure that this organization informs all laboratories that it accredits for fastener testing of their
responsibilities under the Fastener Quality Act.
I will ensure that the organization does not state or imply in any way that it, or laboratories which it
accredits, has(ve) NIST approval/recognition.
Authorized Representative:

Signature

Date

Title

1

If applicable please provide:
Title of document:
Date of approval by Director: