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Clinical Laboratory Improvement Amendments of 1988 (CLIA)

CLIA Application for Certification (CMS-116)

1.   Complete the CLIA Application for Certification (CMS-116), in its entirety,
      for any of the following:
      · Initial Laboratory Certification
      · Change in Certification Type
      · Change in Provider Name
      · Change in Address, Telephone Number, etc.
      · Change in Laboratory Director

2.   Mail completed application to:

    Wyoming CLIA Office:
    Healthcare Licensing and Surveys
    6101 Yellowstone Rd, Ste 186C
    Cheyenne, WY 82002
    Telephone: (307) 777-7123
    Fax: (307) 777-7127

Not a Wyoming laboratory?

Refer to the Federal CLIA page
for contact information in your state.
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Federal Resources for Clinical Laboratories:
       CLIA Brochures
      CLIA Certificate Fee Schedule
      CLIA Regulations and Federal Register Documents
      Interpretive Guidelines for Laboratories
      State Operations Manual - Revisions to Chapter 6: "Special Procedures for Laboratories"