National Voluntary Laboratory Accreditation Program (NVLAP) Information Collection System

National
Voluntary
Laboratory
Accreditation
Program

General
Application
and
Instructions

Notwithstanding any other provision of the law, 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 OMB control
number. The information collected is used by NVLAP to help assess laboratory
compliance with the criteria published in 15 CFR Part 285. Responses to the
collection of information are required for a laboratory to be considered for NVLAP
accreditation. Confidentiality of the information submitted is handled in
accordance with 15 CFR Part 285, Sec. 285.2. The annual public burden for the
collection is estimated to average 2.62 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining
the data 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 Chief, Laboratory
Accreditation Program, NIST, Stop 2140, Gaithersburg, MD 20899-2140.

OMB Number: 0693-0003
Approval Expires: December 31, 2009

NVLAP LAB CODE:

NVLAP GENERAL APPLICATION
1.

LEGAL NAME AND FULL ADDRESS of the laboratory.

Laboratory Name

Address (Line 1)

Address (Line 2)

City

State

ZIP + 4

Country

2.

LABORATORY NAME AS YOU WANT IT TO APPEAR ON THE CERTIFICATE AND SCOPE OF
ACCREDITATION (65-character limit).

3.

LABORATORY URL (web site address). If you wish to have the laboratory's URL (Uniform
Resource Locator) listed in NVLAP's Internet and hard copy directories, enter the URL below. It
is NVLAP's policy to display the URL text only; a web link will not be provided.

4.

FEDERAL TAXPAYER IDENTIFYING NUMBER of the laboratory. As required by the Debt
Collection Improvement Act of 1996 (Public Law 104-134), employer identification numbers or
social security numbers must be collected for debt collection purposes.
___________________________________

5.

Is the laboratory currently NVLAP-accredited for any field of testing or calibration?

9 Yes 9 No.

If yes, please provide its NVLAP Lab Code: __ __ __ __ __ __ - 0

NVLAP GENERAL APPLICATION (REV. 4/03)

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NVLAP LAB CODE:

6.

OWNERSHIP of the laboratory.
Name of owner

Type of ownership (check one):

7.

8.

9 Sole proprietorship 9 Federal government
9 Partnership
9 State government
Corporation
9
9 Municipal government
9 Other

Check one of the following as it applies to the laboratory:
a.

Testing laboratory:

9 Commercial testing service
9 Sometimes available for commercial testing
9 Normally not available for commercial testing

b.

Calibration laboratory:

9 Government
9 Non-government

AUTHORIZED REPRESENTATIVE of the laboratory. The Authorized Representative is
responsible for ensuring that the laboratory complies with the conditions and criteria for
accreditation. This person's name will appear in NVLAP directories and on Scopes of
Accreditation. The Authorized Representative will receive all NVLAP correspondence, receive
proficiency testing materials and reports, and be contacted about on-site assessments.

NAME:
Title:
Phone Number:

Fax Number:

E-Mail Address:

9.

APPROVED SIGNATORY(S) of the laboratory. An Approved Signatory is recognized by NVLAP
as competent to sign accredited laboratory calibration or test reports. The laboratory must
designate one or more staff members as an Approved Signatory. The laboratory's Authorized
Representative may, if appropriate, also serve as an Approved Signatory.
List the Approved Signatory(s) on page 3. If more space is needed, attach additional pages.

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NVLAP LAB CODE:

APPROVED SIGNATORY(S):
NAME 1:
Title:
Phone Number:

Fax Number:

E-Mail Address:
Field(s) of accreditation for which
signatory is approved to sign reports:

NAME 2:
Title:
Phone Number:

Fax Number:

E-Mail Address:
Field(s) of accreditation for which
signatory is approved to sign reports:

NAME 3:
Title:
Phone Number:

Fax Number:

E-Mail Address:
Field(s) of accreditation for which
signatory is approved to sign reports:

NAME 4:
Title:
Phone Number:

Fax Number:

E-Mail Address:
Field(s) of accreditation for which
signatory is approved to sign reports:

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NVLAP LAB CODE:

10. To become accredited and maintain accreditation, the testing or calibration laboratory must
supply its QUALITY MANUAL to NVLAP or its designated contractor. Call NVLAP for specific
instructions regarding the laboratory's Quality Manual for laboratory accreditation program(s)
covered by this application.

11. Attach a detailed organization chart of the laboratory that shows the name, title, and
position for all key laboratory personnel concerned with the Scope of Accreditation. For
laboratories that are part of a larger organization, attach a second organization chart
showing the relationship of the laboratory to other corporate entities or activities.
For the second chart, organizational entity names must be given, but the names of personnel are
not required. In order for NVLAP to assess the laboratory’s comformance with NIST Handbook
150, paragraphs 4.1.4 and 4.1.5, the chart must show all reporting paths from the laboratory
director to other levels of management.

12. Attach a description of the laboratory and laboratory facilities as it applies to the NVLAP
accreditation activities. The description should include laboratory purpose, laboratory size and
layout, staff size, major equipment, and use of remote sites/subfacilities/mobile-units.
Describe the scope of operation of the laboratory in the fields of testing or calibration for which
accreditation is being sought, including an indication of the amount of testing or calibration that
is performed. Note that additional information may be requested in the program-specific
applications.
Include a brief overview of other testing or calibration services offered by this laboratory.

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NVLAP LAB CODE:

CONDITIONS FOR ACCREDITATION
In order to become accredited and maintain accreditation, a laboratory shall agree in writing to:
(1)

comply at all times with the NVLAP criteria for accreditation as set forth in NIST Handbook 150
and relevant technical documents;

(2)

fulfill the accreditation procedure, especially to receive the assessment team, to pay the fees
charged to the applicant laboratory whatever the result of the assessment may be, and to accept
the charges of subsequent maintenance of the accreditation of the laboratory;

(3)

participate in proficiency testing as required;

(4)

follow NVLAP conditions for referencing accreditation status (NIST Handbook 150, Annex A);

(5)

resolve all deficiencies;

(6)

report to NVLAP within 30 days any major changes that affect the laboratory's:

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(7)

legal, commercial, organizational, or ownership status
organization and management; e.g., key managerial staff
policies or procedures, where appropriate
location
personnel, equipment, facilities, working environment or other resources, where significant
Authorized Representative or Approved Signatories, or
other such matters that may affect the laboratory's capability, or scope of accredited
activities, or compliance with the requirements of NIST Handbook 150 and relevant technical
documents;

return to NVLAP the Certificate of Accreditation and the Scope of Accreditation for revision or
other action should it be requested to do so by NVLAP, or become unable to conform to any of
these conditions.

In addition to the confidentiality provisions of NIST Handbook 150 paragraph 1.7, NVLAP, administered by
NIST, and the laboratory seeking accreditation acknowledge and agree that the accreditation assessments
and proficiency testing work done by NIST/NVLAP is done in accordance with the authority granted to NIST
by Title 15 United States Code Section 3710a. The Parties further agree that to the extent permitted by law,
NIST will protect information obtained during application, on-site assessment, proficiency testing,
evaluation, and accreditation from disclosure pursuant to Title 15 USC 3710a(c)(7)(A) and (7)(B) for a period
of five (5) years after it is obtained.
For the first five years that laboratory information is held by NVLAP, both confidentiality provisions will be in
force — NIST Handbook 150 and 15USC3710a.
Information in NVLAP's possession for more than five years will continue to be held in confidence under the
provision of NIST Handbook 150.
As the applicant laboratory's Authorized Representative, I agree to the above conditions for accreditation.
I attest that all statements made in this application are correct to the best of my knowledge and are made
in good faith.

Signature

Date

Printed Name

NVLAP GENERAL APPLICATION (REV. 4/03)

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