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CLIA - Clinical Labs



CLIA Change Form - For laboratories located in Nebraska

A CLIA lab must submit a new CMS-116 form for any of the following:

  • Initial application
  • Survey, initial or recertification
  • Certificate type changes other than to a Certificate of Waiver
  • Reinstatement of a CLIA certificate
  • Director changes
    o PPM (Provider-performed Microscopy) labs
    o Certificate of Compliance labs

For certificate type changes, in addition to the CMS-116 form you must submit a new List of Tests Performed.

For additional questions, please contact:
(402) 471-4363



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