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Grading Certification and Verification
LPS Requesting QSVP Services  
This page is designed to help clients who wish to request services under the Quality Systems Verification Programs (QSVP).

Client responsibilities are outlined in QAD 1000 Procedure, Quality Systems Verification Programs General Policies and Procedures. Program requirements are outlined within individual Program Procedures.

Clients must submit an application for service which includes a completed LPS Form 109 - Application for Service, a cover letter, and a complete copy of the client’s program documentation.

Clients requesting QSVP services for the first time must complete the LPS Form 109. When completing the LPS Form 109, the client must

  • Enter applicant information including name, billing address, physical address, tax id number, telephone number, fax number, and email address;
  • Identify the type of Quality Assessment Division Service requested;
  • Enter the FSIS establishment number if applicable;
  • Identify the type of operations conducted;
  • Identify the legal status of the operation;
  • Identify the financial interest of the applicant;
  • Agree by checkmark to the 4 requirements stated on the right;
  • Sign and date the Form.

The completed LPS Form 109 must be sent to the Quality Assessment Division along with the cover letter requesting service and the program documentation. These documents can be sent via email to or to the address below.

If any information on the original LPS Form 109 changes, then the client must submit a revised, updated LPS Form 109.

National Billing Office
10809 Executive Center Drive
Suite 318
Little Rock, AR 72211
Phone: 501-312-2962
Fax: 501-312-2968

I Want To
  LPS 109 Application for Service PDF file  
  Go to GVD Billing Account Information  
  See an Example Letter for Accreditation Programs - Word Doc  
  See an Example Letter for Audit Programs - Word Doc  
  Contact the GVD Audit Services  
Media Help
  Download Adobe Acrobat Reader  
  Last Modified Date: 06/12/2015