Form 002C Application for Voting System Testing

U.S. Election Assistance Commission

Application for Voting System Testing

1.

Manufacturer Name:

2

Manufacturer Code:

.

3.

Version of Standards to be Used for Testing:

4

0

Voting System Name:

5

0

System ModelNersion Number:

6

.

OMB Control # XXXXX-XXXX

System is: New

Modification

EAC Accredited VSTL:

7.

Requested EAC Certification number:

8.

Brief Description of
System or system
modification:

Signature:

Date:

Form EAC 002C

Page 1 of 3

Instructions
This form provides manufacturers with the means to apply for a certification of a voting system. Completion of a voting
system application is a required step in the EAC Voting System Testing and Certification Program. This form is prescribed by
Section 4.3 of the Manual. For more information on registration requirements please see Section 4.3.
This form is generally self-explanatory, however the numbers and the instructions below correspond to the numbered
sections of the form.
1. Manufacturer Name: Full legal name of the manufacturer.
2. Manufacturer Code: The three letter identification code provided by the EAC upon manufacturer registration.
3. Version of Standards to be Used for Testing: Select the version of the EAC approved voting system standards to which
the candidate system or modification is to be tested and certified.

4-5 Provide information as requested.
6. EAC Accredited VSTL: Provide the name of the EAC accredited voting system test laboratory that will perform testing on

the candidate system.

7. Requested EAC Certification Number: Provide the certification number to be carried by the candidate system following
certification. This number must begin with the three letter manufacturer identification code and be unique only to the
specific candidate voting system. The number may be alpha-numeric and contain no more than 20 characters.
8. Brief Description of the System or System Modification: Describe the system , carefully listing all components

submitted for certification.

This information is required for the EAC to provide for the certification of voting systems as required by 42 U.S.C. Section
15371. This information will be used solely to administer the EAC Testing and Certification Program. This program is
voluntary, however, individuals who wish to participate must meet the requirements of the Program. This information will be
made public consistent with the requirements of the Freedom of Information Act, the Trade Secrets Act, and any other
applicable Federal law or regulation. Public reporting burden for this collection of information is estimated to average about
27 hours for completion of this form. This estimate includes the time for reviewing the instructions, gathering information
and completing the form. Send comments regarding this burden estimate to the Testing and Certification Program Director,
U.S. Election Assistance Commission, 633 3rd Street N.W., Suite 200, Washington, DC 20001. Notwithstanding any other
provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to respond to, or
comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection
of information displays a currently valid 0MB Control Number.

Form EAC 002C

Page 2 of 3

Application for Voting System Testing
(For EAC Use only)

Application Number:

Application Received

Date/Time

Lead Technical Reviewer

Test Plan

Received

Date/Time

Accepted

Test Report

Received

Not Accepted

If Not Accepted, provide attachment for
file containing explanation.

Date/Time

Estimated Date for Completion of Report Review:

Approved

Not Approved

If Not Approved, provide attachment
for file containing explanation.

System Certification Date:

System Certification
Number:

Form EAC 002C

Page 3 of 3