Form 223 Consumer Product Conformity Assessment Body (Testing Lab

U.S. Consumer Product Safety Commission
4330 East West Highway, Bethesda, MD 20814

CPSC Form #223

Consumer Product Conformity Assessment Body (Testing Laboratory)

Registration Form

This registration form and all related materials (certificate, scope documents, and training
materials, if required) must be submitted electronically and in the English language.

The information you provide is encrypted for privacy during transit. Clicking on the Verisign logo to the left displays CPSC's specific server ID information and verifies that this is a legitimate Verisign Secure Site.

Please capitalize only the first letter of words and names (except for abbreviations) when filling out this form. Thank you!

1. Legal name of the laboratory:
*

  2. Full address of the laboratory:

      Address (Line 1) *
      Address (Line 2)
      City *      State/Province: *
      Country or Administrative Area *     Postal Code:

3. Laboratory web site (optional):

4. Registration status (select one):

New Registration

Increase in scope from prior registration

Renewal

Reinstatement

You must select one of the above

5. Laboratory name as you wish it listed on the CPSC web site, if different than legal name (leave blank if same):

  6. Laboratory's authorized representative (to be displayed on the CPSC web site):

      Family name(s):        First (Given) name:
      Title:        E-mail:
      Telephone #:        Fax #:

  7. Applicant Information (Point of contact for registration questions. Not for CPSC web site display. Leave blank if same as above):

      Family name(s):        First (Given) name:
      Title:        E-mail:
      Current Date:     (mm/dd/yyyy) Must be mm/dd/yyyy

8. Ownership / Type of Laboratory:

A. Definitions:

Third Party Laboratory: A testing laboratory that does not have a 10 percent or greater ownership interest by a manufacturer or private labeler of a product subject to the safety requirements for which you are applying and also is not owned or controlled, in whole or in part, by a governmental entity (as defined below for Governmental Laboratory).

Firewalled Laboratory: Ownership of the applicant laboratory of 10% or more by manufacturers or private labelers of children’s products:

Registration as a firewalled conformity assessment body (firewalled laboratory) is required if there are ownership interests in this laboratory of 10% or more by manufacturers or private labelers of children's products subject to the safety requirements for which you are applying. These owners must be identified in the boxes below.

Governmental Laboratory: Ownership or control, in whole or in part, by a governmental entity:

Ownership or control, in whole or in part, of this conformity assessment body by a governmental entity requires registration as a governmental conformity assessment body. If this conformity assessment body is owned or controlled in part or in whole by a government, the governmental entity(s) must be named in the boxes below. This includes indirect ownership or control through governmental ownership of interests in any partners of this conformity assessment body.
The phrase “governmental entity” in this document refers to any governmental entity in your country or administrative area, whether national, provincial, territorial, local, etc., and includes state-owned entities even if those entities do not carry out governmental functions.

*B. Type of Laboratory (select one):

Third Party Laboratory (see attestation)

Firewalled Laboratory

Governmental Laboratory

C. Registration (select one):

Third Party Laboratory:

If Third Party Laboratory is selected, the laboratory representative attests that the laboratory does not have an ownership interest of 10 percent or more by a manufacturer or private labeler of a product subject to the safety requirements for which you are applying and the laboratory also is not owned or controlled, in whole or in part, by a governmental entity (as defined above for governmental laboratory).

* Check this box and submit your name below to confirm third party laboratory attestation.

*Name of Lab Representative making attestation that applicant is a third party laboratory. If attestation is completed, skip to Section 9.

Firewalled Laboratory:

Registration as a firewalled conformity assessment body (firewalled laboratory) is required if there are ownership interests in this laboratory of 10% or more by manufacturers or private labelers of children's products subject to the safety requirements for which you are applying. These owners must be identified in the boxes below.

Name of Owner	Percent Owned (Do not use "%")
* a.	*# only
b.	*# only
c.	*# only
d.	*# only
e.	*# only
f.	*# only
g.	*# only
h.	*# only
i.	*# only
j.	*# only

You may request by checking the box below that the CPSC consider manufacturer or private labeler ownership information as confidential and exempt from public disclosure. This request of confidentiality does not relieve the applicant from the obligation to provide CPSC with the required ownership information.

Check this box if you claim that this information should be considered as confidential and exempt from public disclosure.

Ownership or control, in whole or in part, by a governmental entity:

Ownership or control, in whole or in part, of this conformity assessment body by a governmental entity requires registration as a governmental conformity assessment body. If this conformity assessment body is owned or controlled in part or in whole by a government, the governmental entity(s) must be named in the boxes below. This includes indirect ownership or control through governmental ownership of interests in any partners of this conformity assessment body.

Ownership or control by a governmental entity may not be considered as confidential and exempt from public disclosure.

Name of Governmental Entity	Percent Owned or Controlled (Do not use "%")
* a.
b.	*# only
c.	*# only
d.	*# only
e.	*# only

9. Laboratory Accreditation Information and Scopes for which you are applying:

The laboratory must be accredited by an ILAC-MRA signatory accrediting body. The accreditation must be to ISO Standard ISO/IEC 17025:2005--General Requirements for the Competence of Testing and Calibration Laboratories and the scope of the accreditation must expressly include testing to the CPSC safety requirements for which you are applying.

PLEASE NOTE: If you have scopes that are covered under different or multiple certificate numbers (from the same or different ILAC-MRA member), please fill out the accreditation/certificate information for only those scopes covered under one ILAC-MRA member/certificate number. Follow the instructions in Section 10, and Click “Submit” at the bottom of the form. There will be an opportunity to fill in additional certificate information.

After submitting, you will receive an application summary page that provides an opportunity to verify the application information. Scroll down and put in the second certificate number (and different ILAC-MRA member, accreditation and expiration dates if appropriate), deselect the scopes from the first submission, select new scopes that are covered by the second certificate, and resubmit. You can repeat this process as needed for multiple accreditation certificates.

You must select an ILAC-MRA member from the drop-down list. *

      Name of ILAC-MRA member providing accreditation

      Date of accreditation to ISO/IEC 17025:2005     (mm/dd/yyyy)

      Certificate number *

      Expiration date     (mm/dd/yyyy)

The accreditation and certificate information above applies to the following scopes (check all that apply; if you have been accepted for one of them previously, please do not check it again):

The scope document for the laboratory seeking acceptance of its accreditation must include an explicit reference to each scope below for which it is applying.

    Bicycle Helmets, 16 CFR Part 1203
    Lead Paint, 16 CFR Part 1303
    Clacker balls, 15 CFR Part 1500.86(a)(5)
    Dive Sticks and other similar articles, 16 CFR 1500.86(a)(7) and (8)
    Small Parts Regulation, 16 CFR Part 1501
    Electrically operated toys, 16 CFR Part 1505
    Full-Size Cribs, 16 CFR Part 1508
    Non Full-Size Cribs, 16 CFR Part 1509
    Rattles, 16 CFR Part 1510
    Pacifiers, 16 CFR Part 1511
    Bicycles, 16 CFR Part 1512
    Children’s Bunk Beds, 16 CFR Part 1513
    Children’s Metal Jewelry, CPSC Test Method CPSC-CH-E1001-08 for Determining Total Lead in
Children’s Metal Products and/or the "Screening Test for Total PB Analysis" Section of the
2005 CPSC Laboratory SOP for Determining Lead in Children's Metal Jewelry
    Children’s Metal Products, CPSC Test Method CPSC-CH-E1001-08 for Determining Total Lead in
Children’s Metal Products
    Non-Metal Children’s Products, CPSC Test Method CPSC-CH-E1002-08 Standard Operating Procedure
for Determining Total Lead (Pb) in Non-Metal Children’s Products

10.

All registrants must provide an English language copy of the laboratory accreditation certificate and relevant scope documents.

Please email these materials separately to [email protected] and be sure to include your Laboratory Name, Accreditation Certificate Number, and Scope (Regulation) in the subject line of your message and in the text of your email.

Please attach the full relevant scope document(s) to your application. Do not attach only
sections of your scope document.

Your email should also include information on where to find the CPSC required scope references in your scope documents (e.g., page numbers).

Firewalled conformity assessment bodies must also submit copies of their training materials.
If any manufacturer or private labeler of children's products, subject to the safety requirements for which you are applying, holding ten percent or greater interest in this conformity assessment body is using this entity for the required testing of their products, the conformity assessment body must submit a copy of the firm's established materials used for training its employees on the process and means by which allegations of any attempt by the manufacturer, private labeler or other interested party to hide or exert undue influence over test results can be immediately and confidentially reported to the Commission.

Please email these materials with your certificate and scope documents to [email protected]

KNOWING AND WILLFUL FALSE STATEMENTS MADE ON THIS FORM OR IN ANY OTHER SUBMITTED MATERIALS ARE PUNISHABLE BY FINE AND/OR IMPRISONMENT FOR UP TO FIVE YEARS (U.S. Code, Title 18, Section 1001) AND/OR WITHDRAWAL OF CPSC ACCEPTANCE OF ACCREDITATION.

If you submit and nothing happens, look for a red asterisk(s) ( * ) indicating a required
entry; please complete the entry by the asterisk and re-submit. If submission is
successful, you will get an immediate acknowledgment.

CPSC
Revision 4c

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Form 223 Consumer Product Conformity Assessment Body (Testing Lab

Consumer Product Conformity Assessment Body Registration Form

Consumer Product Conformity Assessment Body (Testing Laboratory).htm

Consumer Product Conformity Assessment Body Registration Form

OMB: 3041-0143

Consumer Product Conformity Assessment Body (Testing Laboratory)