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INSTRUCTIONS FOR PRELIMINARY APPLICANTS

Thank you for your interest in the ANSI National Accreditation Board (ANAB) Personnel Certification Accreditation Program. The purpose of this form is to determine a certification body’s basic eligibility to apply for the program. Before completing this form, please carefully review ISO/IEC 17024:2012 standard and evaluate whether your organization currently complies or will eventually be able to comply with the standard.

GENERAL INFORMATION FOR SUBMISSION

1. Please submit only one application form whether you are applying for one or more certifications for accreditation.

2. Application and all supporting documents shall be submitted in English.

3. Please refrain from editing, altering, or removing any clauses or language from the PCAC-FR-503 preliminary application. ANAB staff reserves the right to ask for the application to be resubmitted if the integrity of this form has been changed.

4. This form is restricted to editing and only allows text to be added. If you are encountering problems using the form please contact ANAB staff.

5. ANAB does not accept hard copies of the preliminary application. Please submit the application and supporting materials electronically to:

Dr. Vijay Krishna

Senior Director of Accreditation, Credentialing Programs

ANSI National Accreditation Board (ANAB)

vkrishna@

GENERAL INFORMATION ON THE PRELIMINARY APPLICATION PROCESS

Once we receive the form, ANAB staff will review it and notify you within 10 business days of one of the following:

a) your organization is eligible to proceed with the application process;

b) your organization will need to provide additional information; or

c) your organization is not eligible to apply.

If you are notified of your eligibility to proceed with the process, we will direct you to complete the full application, send the standard accreditation agreement for signature, and invoice you for the $3,000 application fee. The fee covers processes related to the ANAB Personnel Certification Accreditation program. ANAB staff will check to see if the fee has been paid and the agreement signed before proceeding with the full application review.

For more information on fees associated with the accreditation process please refer to CRED-PR-522 Fees - Accreditation of Credentialing Programs which can be found following this link:

CERTIFICATION BODY INFORMATION

Legal Name of the Certification Body:      

Address:      

Web Site:      

Authorized Representative

Name:      

Title:      

Phone:      

Email:      

Billing Contact

If you are eligible to continue in the accreditation process please indicate the contact to send the $3,000 application fee.

Name:      

Title:      

Phone:      

Email:      

CERTIFICATION PROGRAM(S)

Please list the full name of individual certification program(s) you intend to submit for ANAB accreditation to ISO/IEC 17024:2012:

|Name of Certification scope |Date of first testing |Current number of active certificants |

|1.       |      |      |

|2.       |      |      |

|3,       |      |      |

|4.       |      |      |

|5.       |      |      |

|6.       |      |      |

|7.       |      |      |

|8.       |      |      |

|9.       |      |      |

|10.       |      |      |

*If more than 10, please provide an attachment listing all scopes.

Name of attachment:      

COMPLIANCE WITH ELIGIBILITY REQUIREMENTS

Part 1: Please provide answers in the "Narrative" column and then reference the supporting document(s) in the “Evidence of Compliance” column.

|Requirement |Narrative |Evidence of Compliance |

|1. Certification program has third party |      |      |

|status | | |

|I.e. organizational chart | | |

|2. Legal entity or part of a legal entity |      |      |

|I.e. articles of incorporation, bylaws | | |

|3. Published defined scope for each |      |      |

|certification | | |

|I.e. a brief description for each | | |

|certification being submitted for ANAB | | |

|accreditation | | |

Part 2: Please provide answers to the following questions in the "Narrative" column, supporting evidence is not required for these questions.

|Requirement |Response |Narrative |

|1. Has a Job Tasks Analysis (JTA)/practice |Yes |      |

|analysis been conducted for each certification|No | |

|being submitted? |No, but it is planned | |

| | | |

| |If planned, provide date(s): | |

| |      | |

|2. Has the examination for each certification |Yes |      |

|program being submitted been conducted at |No | |

|least once? |No, but it is planned | |

| | | |

| |If planned, provide date(s): | |

| |      | |

|3. Have reliability estimates been conducted |Yes |      |

|or planned for each certification program |No | |

|being submitted? |No, but it is planned | |

| | | |

| |If planned, provide date(s): | |

| |      | |

|4. Has the certification body conducted an |Yes |      |

|internal audit within the last 12 months to |No | |

|the ISO/IEC 17024 standard to ensure it meets |No, but it is planned | |

|the requirements of this International | | |

|Standard? |If planned, provide date(s): | |

| |      | |

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