NIOSH Standard Application Form 

Module 2 

Guidance on applying for a new air-purifying filtering facepiece respirator (FFR) 

approval

To be used in conjunction with the Standard Application Form (SAF) version 9
In this training module we will discuss how to fill out the NIOSH Standard Application Form 

(SAF v9) for a new respirator approval. The application demonstrated in this module will be 

specific to an air-purifying filtering facepiece respirator (FFR). To learn more about the 

application process for other classifications of respirators or types of applications, please 

reference the August 2015 standard application procedure for the approval of Respirators 

Under 42 CFR 84. . 
Please Note: If this is your first attempt to gain a NIOSH respirator approval and you do not yet have a 

manufacturer code, please register as a new manufacturer by selecting the first option below and clicking the 

continue button to begin the application for a three-character manufacturer code. (Link to Training Module to 

Obtain a Manufacturer’s Code) 
If you already have a NIOSH-issued manufacturer code, select the second option to continue with the 

application for NIOSH approval. Clicking the continue button will display a warning that this action cannot be 

reversed. If you choose the wrong option, do not save the form. You cannot click back to this first question. 

Closing and re-opening the form without saving is the only way to make a different choice. 
Boxes outlined in red indicate a required field. 

C.1.A Enter your NIOSH-assigned manufacturer code. For demonstration, we will use the mock code DWM. 

C.1.B If you have other NIOSH respirator approvals in good standing, check “yes” to indicate that you are currently an 

approval holder. If you do not currently hold any approvals, select “no”. 

C.1.C You must choose your own application reference number. This number should be unique to this application. Do 

not use a reference number that has ever been associated with another application or we will not be able to process 

this form. The only exception is on applications that are being amended at the request of NIOSH. 

*The first three characters of this reference number must be your three-character manufacturer code. 
In Section C2 you will define the type of application

C.2.A In this module, we are applying for a new approval. Please refer to Section 1.2 of the 2016 APR-FFR 

Standard Application Procedure for definitions of the different types of applications. 

C.3.A The manufacturer’s name that you list in section C3 must match what’s on file at NIOSH. If the company 

name or contact information has changed please contact the records room for further guidance . 
C.5.A The status of facility dropdown menu is in reference to the physical work location of the application 

representative. You will have the opportunity to add additional representatives/locations at the bottom of this section. 

You should identify any representatives who would be available to resolve any questions about this application. 

Approval Holder – Choose this option if the representative works out of the office of the approval holder.

Manufacturing Site – Choose this option if the representative is a liaison from the respirator manufacturing site, which 

is not the same location as the approval holding company.

U.S. Contact – Choose this option if the company that is the approval holder is not located within the continental 

United States. This selection indicates that the person listed in this section is the domestic representative that will 

handle the application process correspondence.

Not Certified – Choose this option if you are filling out a new application and the representative is associated with a 

site that does not hold current approval.
C.5.B: If the approval holder will manufacture the respirator associated with this application at an 

alternate location, please indicate that here by listing the manufacturing site name. Otherwise leave 

C.5.B empty.

C.5.C: If the manufacturing site has been used as the primary site for an approval or approval request 

in the last three years, indicate this by selecting “yes” to answer this question. 
Note: Any representatives listed on this 

application must already be on-file at NIOSH. 

If any of the contacts added here are not in 

NIOSH’s system from previous applications, 

please contact the records room. 

C.5.D – C.5.R: List the name of the 

representative including his or her official 

working title, prefix such as Mr., Mrs., or Dr., 

first and last name, optional middle initial, 

and suffix such as Jr. or Sr. Proceed to enter 

the representative’s work address and contact 

information. 

C.5.S: We will need your shipping account 

information if you want your samples 

returned. There may be limitations on 

shipping internationally. Please contact the 

records room to discuss international 

shipping options. 
C.6: Use the dropdown calendar to select the date of application. The date as listed here by the 

manufacturer will not reflect the date of processing by NIOSH.
C.7.A:

Air-Purifying: A respirator that removes contaminants from the ambient air.

Atmosphere-Supplying: A respirator that provides air from a source other than the surrounding 

atmosphere.

As this application is for a filtering facepiece respirator, select “air-purifying”. 
C.8.A: Is this application a resubmittal because it was previously denied? If “yes”, C.8.B will 

populate, asking for all relevant task numbers concerning this re-submittal. (This does not 

apply to a withdrawn application.) 

C.8.C: An amended application is submitted only at NIOSH’s request in order to modify an 

open application that has an error. The application will retain the same Reference Number 

and Task Number. 
C.8.F: Since this is module is meant for filtering facepiece respirator applications, this 

answer will be “no”. 

C.8.D: If this application is in response to any kind of issue found during a site audit or 

certified product investigation (CPIP), C.8.E will populate so that you can enter the task 

number of the site/product audit or CPIP that led to this application. As this module is 

referring to new approvals, this answer will be “no”. 
C.8.G example: A new filtering facepiece application is usually a stand-alone application, but based upon the 

documentation of the company, it can be linked to another project. Two common ways for a filtering facepiece

application to become linked with another application is if the manufacturer uses one matrix to list multiple 

approvals or if the manufacturer places all of their Process Quality Plan (PQP) and inspection criteria within a 

shared document. If this application is linked with another, include the other’s relevant task number in C.8.H.

If there are two or more applications that use the same assembly matrix, identify all subsequent applications in 

C.10, Approval History. The second and subsequent applications using the same assembly matrix cannot be 

processed until the first application is approved. If this section does not apply, check the “no” box.

An FFR cannot be retrofit, therefore C.8.I will be checked “no”. 
C.8.J As you are applying for a filtering facepiece respirator approval, the answers to C.8.J through C.8.M will be 

“no”. 

However, since you are applying for a new respirator approval, the answer to C.8.P will be “yes”. Question C.8.Q

asks you to clarify the source of these samples. (See next slide for C.8.Q definitions)

Use C.8.R to indicate whether you require that NIOSH return test samples to the provided address after they 

have been tested.
Prototype - Defined as a respirator or component that (a) involves a new design produced using rapid prototyping methods, 

temporary tooling, non-production tooling, or regular production tooling in a new fashion, and (b) has demonstrated by the 

applicant’s pre-testing to meet 42 CFR 84 minimum design and performance requirements. Respirators may not be 

submitted for approval while in this defined prototype stage. NIOSH will request samples made on regular production 

tooling and production quality control (Ref. 84.30 (c)) if the approval holder request approval. For non-approval prototype 

testing use a new application form and state “Prototype Testing Only - Respirator is Not Submitted for Approval” in the 

“Reason for Application.”

Regular Production Unit - A respirator or component made on regular production tooling, or that is identical to units made 

using regular production tooling, and is not made with any operations that will not be included in regular production. 

Tooling can be initial tooling or limited production tooling.

Correlation Test - Testing conducted to compare an applicant’s test equipment and results to NIOSH’s. The applicant must 

submit a new application with the wording “Correlation testing only; respirator is not submitted for approval” in the 

“Reason for Application” section.

Note: For more information about test samples, see the APR-FFR Standard Application Procedure, page 19. 
Provide a complete, concise, descriptive reason for the application.

As part of the reason, be certain to address the following:

• Protection level of the respirator (e.g. N95, R95, P100)

• Identify if the respirator contains a carbon or nuisance layer

• Identify if the respirator has an exhalation valve

• Identify if the respirator has any unique features

• FDA clearance (e.g., surgical mask), if applicable

• If the respirator has an antimicrobial or other treatments applied to the respirator - FDA or EPA evaluation

Reference Section 9 (pages 15-16) of the September 16, 2016 Standard Application Procedure for the Approval of Air-Purifying Filtering 

Facepiece Respirators or Section C.9 (pages 27-28) of the August 2015 Standard Application Procedure for the Approval of Respirators 

Under 42 CFR Part 84.

C.9 Reason for Application
MI.A is requesting the product trade name that uniquely identifies the respirator as sold on the 

public market. This name will be listed in the Certified Equipment List on the NIOSH website for 

public reference. You may have an umbrella name for a respirator family that has several models 

within it all under a single approval. 

For an FFR approval, you will not have cause to click the + button to add another model. 
MI.B and MI.C are optional fields. Use MI.C to provide any necessary additional 

information about the model in this entry.
R.A requires you to create a draft approval number. The character schedule for a filtering facepiece respirator is 

84A. Combine this with your manufacturer’s code and the reference number you picked to name your 

application. For our example, this application’s approval number would be 84A-DWM12345. These draft 

approval numbers should appear on the assembly matrix and draft approval labels as well.
The application’s approval number 

should match what is listed on the 

assembly matrix. 

Example from the 2016 APR-FFR 

Standard Application Procedure, page 48. 
R.B This drop down menu will be automatically populated with the trade names entered in the model section above. One of 

these identified trade names must be chosen to represent the model description in this section. 

R.C Choose “Filtering Facepiece”

R.D Choose “Tight” 
R.E. A filtering facepiece respirator should be fit checked, also known as a user seal check, therefore select “yes”. 

R.F. FFRs do not have inhalation valves.

R.G. If the FFR model you are describing has an exhalation valve, indicate that in R.G. 

R.H Because you are applying for an FFR approval, R.H. is not usually applicable. 
R.AP.A: In this dropdown menu, select “Particulate Filtering” 

R.AP.B: Typically an FFR is not powered
R.AP.C: An FFR will have one filter. 

R.AP.D: FFR filters are not replaceable

R.AP.F: Select “Facepiece-mounted”
R.K: Select the FFR particulate protection 

level for this application. 

A list of acceptable multiple protections 

are listed on page 12 of the APR-FFR 

Standard Application Procedure. If a 

multiple level of protection is selected, 

NIOSH will require pretesting for all levels 

of protection and NIOSH will test at all 

levels of protection. 
Section C.13.A will be populated with all the applicable pretests for air-purifying respirators. You 

can select any pretests that the described respirator models have undergone. 
Above is the pretest data required for an FFR. For the required pretest data for all respirator types, see pages 17 

and 18 in the 2016 FFR Standard Application Procedure. For more information about what each pretest entails, 

refer to the Standard Testing Procedures. 
C.15.A Assign a part number to the test sample. This should be the part number identified on the product, 

assembly matrix, and label matrix, not the model number. This number must match any correlating entries in 

the assembly matrix as well as supporting documentation for pretests when applicable. If you are submitting 

items or samples for testing that are not on the assembly matrix, such as the exhalation valve, identify the part 

number of the items. Or, if no part number is available use the term “not available.” 

C.15.B Use this field to enter the name and short description of the test sample. Use C.15.C to enter the quantity 

you are submitting for testing.
Enter the title of the respirators’ quality assurance documents in C.16.A. We are looking for the document name, 

not the file name.

The only required quality assurance document to be listed in this section is the manufacturer's quality 

manual(s). 

If the document has been approved in a previous project, the document should be listed in section C.16, but it 

should not be attached in section C.24. The previous task number information can be placed in the reason for 

application or history section.
Other types of quality assurance documents, not required to be listed in section C.16 at this time, include:

- Related Product Quality Plan (PQP) flowcharts

- Sampling plan and classification of defect documents

- Related inspection documents

- Drawings

- Assembly Matrix

For more information, reference section 3, pages 20-21 of the FFR Standard Application Procedure
C.16.B: Indicate to what revision version/level the applicable quality assurance document refers. 

C.16.D: This answer is “no” when you are a new company with your first approval or the addition of a new 

subcontracting facility. 

The answer is “yes” when the quality manual is already approved. 

C.16.F: This will not be applicable for a new FFR application. Leave this field blank. 
A document specified in section C.16 may correlate to a document attached in section C.24. To minimize the 

duplication of effort, use the provided button to automatically add the entries to section C.24 with temporary 

file names and the title and revision level provided in the C.16 description. 
Section C.17.A – C will populate according to whether or not you used Pay.Gov to pay the standard application fee. 
Any documents listed and attached in section C.24 must be checked in the Checklist that follows. 
When submitting your application for an FFR, your checklist should include the items below. This is an example of what your 

checklist might look like, but please double-check your application to ensure that your checklist includes all the documents 

applicable to your application.

Each of these checked documents should be attached and included with your application package. 

(If applicable) (If you did not use Pay.gov)

(Typically for an FFR, exploded view is the 

major component)
When you have completed your application, authorize the document by electronically signing your initials. Save 

the document and email the application along with the other items “checked” in the list above to 

recordsroom@cdc.gov