TX HHS Form 3225. Application for Certification – Supplement to CMS 116

The TX HHS Form 3225, "Application for Certification – Supplement to CMS 116", is a crucial document that helps laboratories obtain certification under the Clinical Laboratory Improvement Amendments (CLIA) program. This form serves as a supplement to completing the Centers for Medicare & Medicaid Services Form CMS 116 and provides additional information required for laboratory certification.

Key features of this form include identifying information about the laboratory, such as its name, CLIA number, and federal tax ID number. The form also requires disclosure of ownership, including the names, addresses, and employer identification numbers (EINs) of individuals or organizations having direct or indirect ownership of a controlling interest in the entity.

This form should be used by laboratories seeking certification under the CLIA program. It is essential to complete this form accurately and thoroughly, as it provides critical information for the certification process. The TX HHS Form 3225 is a vital tool for laboratories looking to obtain or maintain their certification and ensure compliance with federal regulations.