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How to Complete The CLIA Application For Dentistry CLIA Application – Section 1  Check Initial Application Leave CLIA ID blank for new applications DO NOT use DBA. Tax ID must match facility name. Name of Director is generally the provider.  CLIA Application – Section 2  Check only the first box, Certificate of Waiver. CLIA Application – Section 3 CLIA Application – Section 4 CLIA Application – Section 5 Most offices will apply for a single site application.  Read carefully.  If No, skip to section VI.  CLIA Application – Section 6  List specific test type which must be CLIA Waived.  Estimate total annual volume.    CLIA Application – Section 7 and 8 Skip for Waived Tests CLIA Application – Section 9 Check FOR PROFIT, 04 Proprietary CLIA Application

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