Prepare to Submit the Certification for Initial Listing Form
The Certification for Initial Listing Form requires the name, address, and other administrative information about the entity applying for listing as a PSO and any parent organization(s), if applicable (including their alternate legal names, if any). The applicant must also disclose in the Certification for Initial Listing Form if the entity (under its current name or any other) has previously been denied listing, or if listed, was delisted; and if any of the applicant entity's officials or senior managers held comparable positions of responsibility in such an entity.
The Certification for Initial Listing Form may be submitted whenever the prospective AO is able to accurately make the required attestations and certification. The individual who will serve as the PSO's AO if the PSO is listed must be legally authorized to complete the Certification for Initial Listing Form on behalf of the entity seeking listing as a PSO and must certify that the "…statements on this form, and any submitted attachments or supplements to it, are made in good faith and are true, complete, and correct to the best of my knowledge and belief. I understand that a knowing and willful false statement on this form, attachments or supplements to it, can be punished by fine or imprisonment or both (United States Code, Title 18, Section 1001)…"
There are no fees to apply for listing. AHRQ will acknowledge the form upon receipt and will contact the applicant shortly thereafter to begin the initial listing process.
Technical assistance calls with the AHRQ PSO team provide an informal opportunity to discuss specific questions about the requirements. Calls can be arranged at no charge before and after completing and submitting the Certification for Initial Listing Form and at any time after listing. Contact us at firstname.lastname@example.org.
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