Laboratories - Clinical

CLIA Program
Clinical Laboratory Improvement Amendments

The federal government requires that all entities performing laboratory testing (except for research purposes) on humans be certified and in compliance with the regulations for Clinical Laboratory Improvement Amendments (CLIA) to ensure quality laboratory testing.

For assistance with answering your questions or completing your CLIA Application contact our office:

Diana Meyer
Program Manager
(402) 471-3484
Val Ryckman
Hlth Fac Surveyor Consultant II
(402) 471-8687
Suzette Moeller
Staff Assistant II
(402) 471-4363
Mailing Address:

DHHS, Division of Public Health
Licensure Unit - Facilities
PO Box 94986
Lincoln, NE 68509-4986
FAX: (402) 471-0555

Information on the CLIA Program is available on the internet.  The web address is:


  1. Regulations are titled "CLIA Regulations Part 493--Most current – Includes all changes through 1/24/03 (CDC Site)
  2. Interpretive Guidelines are titled "New Appendix C, Survey Procedures and Interpretive Guidelines for Laboratories and Laboratory Services

Click this link for the FDA CLIA Home Page


The CLIA Application for Certification form CMS-116 is available on the internet.  The web address is:

The State of Nebraska requires that two additional forms be completed along with the CMS-116 Application for Certification Form: 

pdficon.gif (134 bytes) CLIA Ownership Information Form

pdficon.gif (134 bytes) List of Tests Performed


The State of Nebraska does not have licensure requirements for laboratory personnel or laboratories.   The State of Nebraska fully participates in the Federal CLIA program and any laboratory or laboratory personnel operating in the State of Nebraska or testing samples from the State of Nebraska must follow the Federal CLIA regulations.


A current listing of the FDA CLIA Waived Test List is available from the internet at the following websites:

If you want to check a test’s complexity, go to this website:


Laboratories certified under the CLIA program must meet the following conditions:

(a) Notify HHS or its designee within 30 days of any change in--

  1. Ownership;
  2. Name;
  3. Location;
  4. Director; or
  5. Technical supervisor (laboratories performing high complexity only).

New-Laboratory Changes that Require Submitting a New Form CMS-116

A new form CMS-116 MUST be obtained when any of the following laboratory changes takes place:

  • Initial application
  • Survey, initial or recertification
  • Status changes other than to a Certificate of Waiver
  • Reinstatement of CLIA certificate
  • Director change (Provider-Performed Microscopy (PPM) Certificate or Certificate of Compliance)

For ownership changes - also complete the CLIA Ownership Information Form.

For certificate type changes - also complete the List of Tests Performed.

pdficon.gif (134 bytes) CLIA Change form

pdficon.gif (134 bytes) CLIA Ownership Information Form

pdficon.gif (134 bytes) Lists of Tests Performed

pdficon.gif (134 bytes) Guidelines for Counting Tests

pdficon.gif (134 bytes) CLIA CMS-116 Form- Clinical Laboratory Improvement Amendments Application for Certification

Documents in PDF format require the use of Adobe Acrobat Reader which can be downloaded for free from Adobe Systems, Inc.  Get Adobe Acrobat Reader

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