EAC-ESTEP-001B ESTEP Manufacturer Registration Form

U.S. Election Assistance Commission

Election-Supporting Technology
Manufacturer Registration Application

OMB Control # XXXX-XXXX
Expires: 9/30/2025

1. Manufacturer Information
Legal Name of Business:

Address of Business:

City

Organization Type:

State

Corporation

Partnership

Zip Code

Sole Proprietor

Other
(Please Explain)

Name of Individual or Entity
with Controlling Ownership
of Organization:

Name of Individual or Entity
with Foreign Ownership
Interest in Organization:

Name of Officers, Board
Directors, and all Partners:

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2. Management Representative
Representative Name:
(Last, First, Middle Initial)
Title or Designation:

Phone Number:

(

)

-

Email:

Full Mailing Address:
(If different from business)
City

State

Zip Code

3. Technical Representative
Representative Name:
(Last, First, Middle Initial)
Title or Designation:

Phone Number:

(

)

-

Email:

Full Mailing Address:
(If different from business)
City

State

Zip Code

4. Briefly describe your quality system (e.g. ISO 9001). Provide your written policies supporting this description as a
part of this application.

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5. Briefly describe your internal requirements for managing change control/version control for both
hardware/firmware and software, as applicable. Provide your written policies supporting this description as part of
this application.

6. Briefly describe document retention requirements. Provide your written policies supporting this description as
part of this application.

7. List the name, address, city, state/province, postal code, country, and phone number for all facilities used by your
company to manufacture your product, and the name, title, address, email address, and phone number for a
person at each facility.

8. Manufacturer Registration Agreement
To protect the integrity of the program and promote quality assurance, manufacturers must agree to all provisions
as stated in the Manufacturer Agreements section in the currently effective Election Supporting Technology
Evaluation Program Manual.
Signature:
(Handwritten or Digital)
Title:
Date:
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For EAC Official Use Only
Manufacturer’s Designation:
Notes:

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Instructions
This form provides for the registration of election-supporting technology manufacturers. Registration is the initial required step in
the EAC Election Supporting Technology Evaluation Program (ESTEP). This form is prescribed by the Program Manual of the
Election Supporting Technology Evaluation Program.
This form is generally self-explanatory, however, the numbers and the instructions below correspond to the numbered sections of the
form.

1. Manufacturer Information
• Name of Individual or Entity with Controlling Ownership in the Manufacturer: Ensure that the controlling individual is properly
named and an address is provided.
• Name of Individual or Entity with Foreign Ownership Interest: Ensure that any individual or entity with foreign ownership is
properly named and an address is provided.
• Names of Officers and/or Board of Directors and/or all Partners: Ensure that all individuals are identified by name and title.

2. Management Representative: Please provide the name and information requested for the designated Manufacturer Representative.
3. Technical Representative: Please provide the name and information requested for the designated Technical Representative.
4-7. System Identification: Provide information as requested and attach to your submission the written documentation required.

8. Manufacturer Certification Agreement: Manufacturers are required to take or abstain from certain actions consistent with the
certification program. Your concurrence to these requirements is signified by affixing the signature of the manufacturer representative.
If there are any questions regarding this form, please contact ESTEP via estep@eac.gov.
Maintaining Registration
The EAC will contact the manufacturer representative within 10 business days of form submission to confirm whether the application has
been accepted or rejected. After a manufacturer has received notice that it is registered, it is eligible to participate in the program.
Manufacturers will be issued a unique, three-letter identification code that is used to identify the manufacturer and its products.
Manufacturers are required to keep all registration information up to date. Manufacturers must submit a revised application form to the
EAC within 30 days of any changes to the information required on the application form. Manufacturers will remain registered participants
in the program during this update process. The EAC will add the manufacturer to the EAC’s listing of registered manufacturers that is
publicly available at http://www.eac.gov.
This information will be used solely to administer the EAC Election Supporting Technology Evaluation 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 Election Supporting Technology Evaluation 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 XXXX

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