Consumer Product Conformity Assessment Body (Testing Laboratory)

Registration Form: Initial request for first time user

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

Please capitalize only the first letter of words and names (except for abbreviations) when filling out this form. Note an asterisk (*) denotes a required field. Thank you!
 
 

  2. Full address of the laboratory:       
      
      
            
  *Country or Administrative Area           

 
 

 
 

  5. Laboratory's authorized representative (to be displayed on the CPSC website):
    
              
                  
            

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

              
              

  7. 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 government entity (as defined below for Government Laboratory)

Firewalled Laboratory: Ownership of the applicant laboratory of 10% or more by a manufacturer or private labeler 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 a manufacturer or private labeler 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):


C. Registration (complete the appropriate section)

Third Party Laboratory Registration

If Third Party Conformity Assessment Body 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. If attestation is completed, skip to Section 8.



Firewalled Laboratory Registration

Registration as a firewalled conformity assessment body (firewalled laboratory) is required if there is an ownership interest in this laboratory of 10% or more by a manufacturer or private labeler 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 "%")
 
 
 
 
 
   
 
 
   
   


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.

, I claim that this information should be considered as confidential and exempt from public disclosure.


Registration for 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
(Do not use "%")
   
   
   
   
   

8. Laboratory Accreditation Information and Scope for which you are applying:

The Laboratory must be accredited by an ILAC-MRA signatory accreditation 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 the CPSC rules and/or test methods for which you are applying.

If all CPSC rules and/or test methods for which you are applying fall under one certificate, enter the information under Certificate 1 and check all of the applicable CPSC rules and/or test methods. Leave Certificate 2 information blank.

If the list of CPSC rules and/or test methods on your application are split between different certificates (from the same or different ILAC-MRA signatory accreditation body), enter the information for both Certificate 1 and Certificate 2 and check only the CPSC rules and/or test methods that are applicable to each certificate.

Certificate 1

You must select an ILAC-MRA signatory accreditation body from the drop-down list.
*Name of ILAC-MRA signatory accreditation body providing accreditation 		*Date of Accreditation to ISO/IEC 17025:2005 (mm/dd/yyyy)  

*Certificate number
Expiration date (mm/dd/yyyy)
 

 


Certificate 2 (Leave it blank if you do not have a second certificate)

You must select an ILAC-MRA signatory accreditation body from the drop-down list.
Name of ILAC-MRA signatory accreditation body providing accreditation 		Date of accreditation to ISO/IEC 17025:2005(mm/dd/yyyy)  

Certificate number
Expiration date(mm/dd/yyyy)
    

 

You must upload at least one certificate and scope document for each certificate you reference above. The form will not submit until you upload them using the "Upload Document" button below.

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 10% 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 include these materials when clicking "Upload Document" to upload your certificate and scope documents.




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).



               

CPSC Form 223
OMB Control Number 3014-0143