Page 2 of 2 Revised 10/15/2019
Mat
erials Checklist (Indicate materials submitted with an “X”)
Completed application Form 200
If applicable, attach Form 200 - Schedule A, listing recommendations/issues made from previous Texas
examination. List how they have been corrected or addressed. If they have not, explain why.
If component has been modified, include log detailing changes from the previously Texas certified version
Report from a NIST-certified testing laboratory demonstrating that the e-pollbook system meets the
requirements of the Texas Technical Testing Matrix for e-pollbooks.
The Technical Data Package (TDP), which includes: Operating, Support, and Maintenance Manuals,
Training Materials and Instruction Guides, Recommended Use Procedures, Software License Agreement,
Software System Design, Warranty Information, and Recommended Security Practices
All certifications and denials of certification for the system in other jurisdictions
A list of any and all known anomalies experienced with the use of the e-pollbook system and a description of
the resolution of each anomaly, attach Form 200-Schedule A
List of all consumables required for the continued operation of the system, and the supply chain for those
consumables
List of compatible peripheral devices used with the e-pollbook system
A statement regarding any foreign ownership interested in the e-pollbook system
A description of additional compatible languages (if any)
A description of accessibility features (if any)
Screenshots of all phases of the pollbook process that interact with election workers and/or voters
Ac
knowledge which NIST-certified test laboratory has been notified to send a copy of the report based off
the Texas Technical Training Matrix and expected delivery date to our office.
NIST-certified test laboratory Name
Ad
ditional Comments:
Signature of Person Making Request
Please submit and all relevant materials to:
El
ections Division
P.O. Box 12060
Austin, Texas 78711-2060
