Consumer Product Conformity Assessment Body Acceptance

U.S. Consumer Product Safety Commission
4330 East West Highway, Bethesda, MD 20814 CPSC Form #223

Consumer Product Conformity Assessment Body Acceptance

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.
Please see the box between sections 9 and 10 below for details.

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.

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. Registering as a (select one):
Firewalled Conformity Assessment Body
Third Party Conformity Assessment Body
Government Conformity Assessment Body

4. Registration status (select one):
New Registration
Increase in scope from prior registration
Renewal
Reinstatement

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.

Name of Owner	Percent Owned
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

  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.

Name of Government Entity	Percent Owned
a.
b.
c.
d.
e.

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

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