Information Needed for Your Application: Mammography (Revised 12-12-19)

Katie Albus

Modified on: Thu, 26 Jan, 2023 at 8:43 AM

Revision History

If this is your first time applying for accreditation at a location , you will need all information detailed in the table below. If this is a renewal or reinstate application, the accreditation system will pre-populate previously submitted data. If any information has changed since the last application, please change it in your application. You will not be able to make changes once the application is submitted.

Section 1: Facility Information

Section 2: Modality Information

Section 3:

Personnel, Equipment, Payment & Submission

Information in this section should be true for your mammography facility.

Facility name
Location address
Mailing address
Employee Identification Number (EIN)*
Facility owner, lead interpreting physician, president/CEO
Practice setting information
Survey Agreement
MQSA Information Release Authorization

Mammography-specific information:

Technologist contact person
Number of mammograms performed in the prior 12 months (screening, diagnostic, undifferentiated); if you are a new facility, you will be asked to submit all patient volume data available
Unit details (number of units, manufacturer/model, serial number, year manufactured, most recent equipment evaluation/physics survey)
Confirmation of all required FDA Quality Standards

Personnel: List interpreting physicians, physicists and technologists.
Equipment and QC forms relevant to the unit(s) being accredited
Payment information

*Also known as a “Federal Tax ID Number”, your EIN is a 9-digit number that the IRS assigns in the following format: 12-3456789. The IRS uses the number to identify taxpayers who are required to file various business tax returns. You must also use your EIN when filing a CMS (Medicare) claim. EINs are used by employers, sole proprietors, corporations, partnerships, nonprofit organizations, trusts, estates of decedents, government agencies, certain individuals, and other business entities. You should ask your business office for your facility’s EIN number.

The ACR accepts faxed, electronic, or digital signatures for accreditation applications. These will be treated as legally binding.

New facilities will be assigned a unique identification number after the online application is submitted. This number appears on all correspondence from the ACR and your online records. Please use this number on all submitted materials and to identify your facility when contacting the ACR for assistance.

Revision History for this Article
Date	Section	Description of Revision(s)
12-12-19	All	Article created; FAQs incorporated; No criteria changes

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