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
Please Select
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (see Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Postal Code:
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:
Family name(s): First (Given) name: Title: E-mail: Telephone #: Fax #:
7. Laboratory Accreditation Information:
Date of accreditation to ISO/IEC 17025:2005 Name of ILAC-MRA member providing accreditation Certificate number Expiration date
8. Laboratory web site (optional):
9. Ownership:
Name(s) of all manufacturers and/or private labelers, of children's products subject to the safety standards for which you are applying, holding ten percent or greater interest in this conformity assessment body.
Identification of such owners is required in the boxes below. You may request by checking the box below that the CPSC consider this submitted ownership information as confidential and exempt from public disclosure.
Check this box if you claim that this information should be considered as confidential and exempt from public disclosure.
If this conformity assessment body is owned or controlled in part or in whole by a government, name the government entity(s) in the boxes below. Ownership or control by a government entity may not be considered as confidential and exempt from public disclosure.
All registrants must provide a copy of the laboratory accreditation certificate and relevant scope documents in addition to this registration form. Firewalled conformity assessment bodies must also submit copies of the training materials noted in section 11. Please email these materials separately to labaccred@cpsc.gov and be sure to include your Laboratory Name, Accreditation Certificate Number, and Scope (Regulation) in the subject line of your message.
10. Seeking CPSC acceptance for the following (check all that apply; if you have been accepted for one of them previously, please do not check it again):
Lead Paint, 16 CFR Part 1303
Pacifiers, 16 CFR Part 1511
Non Full-Size Cribs, 16 CFR Part 1509
Full-Size Cribs, 16 CFR Part 1508
11. Firewalled conformity assessment body training materials If any manufacturer or private labeler of children's products, subject to the safety standards 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
12. Applicant Information:
Family name(s): First (Given) name: Title: E-mail: Current Date:
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 4b