U.S. Election Assistance Commission 

OMB Control # 3265-0024 Application Expires: 9/30/2025 for Voting System Testing 

1 . Manufacturer Name: 

2. 

Manufacturer Code:

3. 

4 0 

Version of Standards to be Used for Testing:

Voting System Name: 

5 0 System ModelNersion Number: System is: New Modification

6. 

EAC Accredited VSTL:

7. Requested EAC Certification number:

8. Brief Description of

System or system

modification:

Signature: 

Date: 

Form EAC 002C Page 1 of 3 
Instructions 

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. Brief Description of the System or System Modification: Describe the system , carefully listing all components

submitted for certification.

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 is

voluntary, however, individuals who wish to participate must meet the requirements of the Program. This information will be 

made 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, 633 3rd Street N.W., Suite 200, Washington, DC 20001. Notwithstanding 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 0MB Control Number. 

Form EAC 002C Page 2 of 3 
Application for Voting System Testing 

(For EAC Use only) 

Application Number: 

Application Received Date/Time 

Lead Technical Reviewer 

Test Plan Received Date/Time 

Accepted Not Accepted If Not Accepted, provide attachment for 

file containing explanation. 

Test Report Received Date/Time 

Estimated Date for Completion of Report Review: 

If Not Approved, provide attachment Approved Not Approved for file containing explanation. 

System Certification Date: 

System Certification 

Number: 

Form EAC 002C Page 3 of 3