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Clinical Laboratory Improvement Amendments of 1988 (CLIA)

CMS-116 (CLIA Application for Certification):

Complete the CMS-116 Application for Certification, 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

For laboratories located in the State of Wyoming, mail the completed and signed CMS-116 Application for Certification to the address listed below. 

Mailing address (Wyoming Laboratories only):
       CLIA Certification
       Healthcare Licensing and Surveys
       6101 Yellowstone Rd.
       Ste. 186C
       Cheyenne WY  82002


Not a Wyoming laboratory?  Refer to the Federal CLIA home page for contact information in your home state.

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

Federal Resources for Clinical Laboratories:

   CLIA Certificate Fee Schedule

   CLIA Regulations and Federal Register Documents

   Interpretive Guidelines for Laboratories and Laboratory Services

   State Operations Manual - Revisions to Chapter 6: "Special Procedures for Laboratories"
       Effective Date:  May 8, 2009 (220 pages)


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