Participation Request Webpage

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The Participation Request Form is for new participants requesting proficiency testing (PT) and quality control (QC) materials. Complete all sections to avoid delays in the process of your request.If you have any questions, please email NSQAPDMT@cdc.gov or call 770-488-4582. All enrollment applications and additional program requests are not guaranteed and will be reviewed.

Are you a current participant in NSQAP or have you received materials from NSQAP in the past year?

Select Option

GENERAL INFORMATION

Laboratory Code Number

Country

If "Yes", what product(s)? *

Desired Program Participation

Schedule (International)

Registration Deadline is October 31.

Schedule (Domestic)

Registration Deadline is August 31.

LABORATORY AND SHIPPING INFORMATION

Provide physical street address. FedEx will not deliver to PO Boxes
Use only English alphabet A-Z, a-z and 0-9. Max entry length 35 characters.

Contact First Name:

Contact Last Name:

Laboratory Name:

Laboratory Address 1:

Laboratory Address 2

City:

State/Province:

Telephone:

Postal Code:

Website address:

Is Shipping address same as above?

Shipping

Shipping Address: (if different from laboratory address)

Shipping Address 1

Shipping Address 2

Shipping City

Shipping State/Province

Shipping Country

Shipping Postal Code

Tax ID Number

Any documents, import permits, fees, taxes, or other costs required by your country for release of your package from Customs are your responsibility. If Tax ID Number is not required to receive FedEx shipment, enter N/A

Laboratory's Tax Identification Number

PROGRAM SELECTION

Quality Control Testing Materials

Second-Tier Quality Control Testing Programs - Enrollment not guaranteed and will be subject to review

Second-tier Congenital Adrenal Hyperplasia by LC-MS/MS (CAHQC)

(Laboratory assessment of CAH is performed by 2nd tier MS/MS, with reporting of one or more of the following analytes: 17 α-Hydroxyprogesterone, 4-Androstenedione, Cortisol, 11-Deoxycortisol, 21-Deoxycortisol)

Second-tier Maple Syrup Urine Disease and Phenylketonuria by LC-MS/MS (MSUD-PKUQC)

(Analyte: Alloisoleucine, Isoleucine, Leucine, Phenylalanine, Tyrosine, Valine)

Second-tier Methylmalonic/Propionic Acidemia and Homocystinuria by LC-MS/MS (MMA- HCYQC)

(Analytes: Malonic Acid, Methylmalonic Acid, Ethylmalonic Acid, 2-Methylcitric Acid, Total Homocysteine)

*-Required Field.

Form Approved
OMB No. 0920-1389
Exp. Date 03/31/2026