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NC Division of Health Service Regulation
Acute and Home Care Licensure and Certification Section
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Acute and Home Care Licensure and Certification Section
CLIA
Forms
Forms
Application to apply for CLIA Certification or to request changes to current certifications
CMS form 116
State of NC HIV Testing, MAM Screening & PAP Screening Applications
HIV Testing Initial & Renewal Application
(PDF, 81 KB)
Mammography Screening Initial & Renewal Application
(PDF, 81 KB)
PAP Smear Screening Initial & Renewal Application
(PDF, 75 KB)
Instructions for paying CLIA fees online
Pay.gov Instructions
(PDF, 100 KB)
Facts and Figures
Forms
Frequently Asked Questions
N.C. Fee Schedule
