Participation Request Webpage

This Participation Request Webpage is ONLY FOR NEW LABORATORIES asking to join the Newborn Screening Quality Assurance Program (NSQAP).

Do not use this form if you are a current participant with an NSQAP Lab Code Number. Your request will be denied.
Refer to FAQs to add programs if you are a current participant https://nbs.dynamics365portals.us/faqs/
Complete ALL sections.
All requests for participation are reviewed and are not guaranteed.
Refer to the FAQs for more information: https://nbs.dynamics365portals.us/faqs/
For questions, email NSQAPDMT@cdc.gov

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

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

17 α-Hydroxyprogesterone + Total Galactose (17OHPQC and TGalQC)

Galactose-1-phosphate Uridyltransferase (GALTQC)

anti-HIV-1 Antibodies (HIVQC)

Immunoreactive Trypsinogen (IRTQC)

Lysosomal Storage Disorders (LSDQC)

(Analytes: Galactocerebrosidase, Acid α-Glucosidase, α-L-Iduronidase α-Galactosidase, β-Glucocerebrosidase, Acid Sphingomyelinase)

Tandem MS 1 (MSMS1QC)

(Analytes: Arginine, Alanine, Citrulline, Creatine, Creatinine, Guanidinoacetic Acid, Glycine, Leucine, Methionine, Ornithine, Phenylalanine, Succinylacetone, Tyrosine, Valine, C0, C2, C3, C3DC, C3DC+C4OH, C4, C4OH, C5, C5:1, C5DC, C5OH, C6, C8, C10, C12, C14, C14:1, C16, C16OH, C18, C18OH, C20-LPC, C22-LPC, C24-LPC, C26-LPC)

Thyroxine (T4QC)

Thyroid-Stimulating Hormone (TSHQC)

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)

(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)

Accept simplified reporting of QC certificate dat

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