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laboratory field services

Major & Minor Changes of Ownership

Definition:

A major change in ownership” means a change in ownership where 50 percent or more of the ownership interest is owned by persons other than the owners to whom the current clinical laboratory registration is issued. See BPC 1211 (f). The laboratory must submit a completed application for a new clinical laboratory registration within 30 days of a major change of ownership or cease engaging in clinical laboratory practice. 

 

Major Change of Ownership

Required State Forms:

Original signatures and dates must be on all forms. Copies are not acceptable.

State Forms:

State forms below and more can be accessed on the Laboratory Field Services (LFS) forms page.

Required Federal Form:

For major changes in your site since the last renewal, please complete and mail the required federal form, CMS 116 to the address below.

  • CMS 116 (PDF) -- CLIA application for new or for changes in your site such as change in laboratory director, ownership, change in certificate type, address, etc.

Required Fee:

Submit registration fee payable in the form of a check or money order to the State of California Department of Public Health. Credit card payments are not accepted. The fee is non-refundable and subject to change with each fiscal year.

For a full list of clinical laboratory registration fees please refer to the Laboratory Field Services (LFS) fee schedule (PDF).

Mail to:

California Department of Public Health
Laboratory Field Services
850 Marina Bay Parkway, Bldg. P, 1st Floor
Richmond, CA 94804-6403

  

​Minor Change of Ownership/Representative Only

These instructions apply only if there has been no change in tax ID number or legal name of owner(s).

Required State Forms:

Required Federal Form:

For minor changes in your site since the last renewal, please complete and mail the required federal form, CMS 116 to the address below.

  • CMS 116 (PDF) -- CLIA application for new or for changes in your site such as change in laboratory director, ownership, change in certificate type, address, etc.

Mail to:

California Department of Public Health
Laboratory Field Services
850 Marina Bay Parkway, Bldg. P, 1st Floor
Richmond, CA 94804-6403

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