United States Election Assistance Comittee

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Application for System Testing Web Form


OMB Control #3265-0004

This form provides manufacturers with the means to apply for a certification of a voting system. Completion of a voting system application is a required step in the EAC Voting System Testing and Certification Program. This form is prescribed by Section 4.3 of the Manual. For more information on registration requirements please see Section 4.3.

This form is generally self-explanatory, however the numbers and the instructions below correspond to the numbered sections of the form.

1. Manufacturer Name: Full legal name of the manufacturer.

2. Manufacturer Code: The three letter identification code provided by the EAC upon manufacturer registration.

3. Version of Standards to be Used for Testing: Select the version of the EAC approved voting system standards to which the candidate system or modification is to be tested and certified.

4-5 Provide information as requested.

6. EAC Accredited VSTL: Provide the name of the EAC accredited voting system test laboratory that will perform testing on the candidate system.

7. Requested EAC Certification Number: Provide the certification number to be carried by the candidate system following certification. This number must begin with the three letter manufacturer identification code and be unique only to the specific candidate voting system. The number may be alpha-numeric and contain no more than 20 characters.

8. Configuration: A complete list of each configuration of the system’s components which could be fielded as the certified voting system.

9. Coding Convention Declaration: Each voting system component is to have a single coding convention selected for every programming language used in the candidate voting system. This information shall include system component, language used, convention declared, and source of convention.

10. Brief Description of the System or System Modification: Describe the system, carefully listing all components submitted for certification. Include whether this application is for a new system or a modification to a previously EAC certified system.

11. Implementation Statement: The Manufacturer must submit with the application form a copy of the voting system’s Implementation Statement, which must meet the requirements of the VVSG (VVSG 2005 – Version 1.0, Vol. I, Section 1.6.4). If an existing system is being submitted with a modification, the Manufacturer must submit a copy of a revised Implementation Statement.

12. Functional Diagram: The Manufacturer must submit with the application form a high-level Functional Diagram of the voting system which includes all of its components. The diagram must portray how the various components relate and interact.

13. System Overview: The Manufacturer must submit with the application form a copy of the voting system’s System Overview documentation submitted to the VSTL as a part of the Technical Data Package. This document must meet the requirements of the VVSG (VVSG 2005 – Version 1.0, Vol. II, Section 2.2).

Application Form

    indicates required field
1. Manufacturer Name:
2. Manufacturer Code:
3. Version of Standards to be Used for Testing:
4. Voting System Name:
5. System Model/Version Number:
6. EAC Accredited VSTL:
7. Requested EAC Certification number:
8. Configuration:
9. Coding Convention Declaration:
10. Brief Description of System or System Modification:
11. Implementation Statement:

File types allowed:
12. Functional Diagram:

File types allowed:
13. System Overview:

File types allowed:
14. Signature:

File types allowed:

This information is required for the EAC to provide for the certification of voting systems as required by 42 U.S.C. Section 15371. This information will be used solely to administer the EAC Testing and Certification Program. This program isvoluntary, however, individuals who wish to participate must meet the requirements of the Program. This information will bemade public consistent with the requirements of the Freedom of Information Act, the Trade Secrets Act, and any other applicable Federal law or regulation. Public reporting burden for this collection of information is estimated to average about 27 hours for completion of this form. This estimate includes the time for reviewing the instructions, gathering information and completing the form. Send comments regarding this burden estimate to the Testing and Certification Program Director,U.S. Election Assistance Commission, 1201 New York Avenue, NW, Suite 300, Washington, DC 20005. Not withstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to respond to, or comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information displays a currently valid OMB Control Number.