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Application Data Sheet 37 CFR 1.76 (EFS-Web Submission) Form. This is a Official Federal Forms form and can be use in EFS-Web US Patent Office.
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Tags: Application Data Sheet 37 CFR 1.76 (EFS-Web Submission), PTO-SB-14, Official Federal Forms US Patent Office, EFS-Web
PTO/SB/14 (11-08)
Approved for use through 01/31/2014. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number.
Application Data Sheet 37 CFR 1.76
Attorney Docket Number
Application Number
Title of Invention
The application data sheet is part of the provisional or nonprovisional application for which it is being submitted. The following form contains the
bibliographic data arranged in a format specified by the United States Patent and Trademark Office as outlined in 37 CFR 1.76.
This document may be completed electronically and submitted to the Office in electronic format using the Electronic Filing System (EFS) or the
document may be printed and included in a paper filed application.
Secrecy Order 37 CFR 5.2
Portions or all of the application associated with this Application Data Sheet may fall under a Secrecy Order pursuant to
37 CFR 5.2 (Paper filers only. Applications that fall under Secrecy Order may not be filed electronically.)
Applicant Information:
Applicant 1
Applicant Authority
Prefix Given Name
Inventor
Legal Representative under 35 U.S.C. 117
Middle Name
Residence Information (Select One)
City
US Residency
State/Province
Party of Interest under 35 U.S.C. 118
Family Name
Non US Residency
Suffix
Active US Military Service
i
Country of Residence
i
Citizenship under 37 CFR 1.41(b)
Mailing Address of Applicant:
Address 1
Address 2
City
Postal Code
State/Province
i
Country
All Inventors Must Be Listed - Additional Inventor Information blocks may be
generated within this form by selecting the Add button.
Add
Correspondence Information:
Enter either Customer Number or complete the Correspondence Information section below.
For further information see 37 CFR 1.33(a).
An Address is being provided for the correspondence Information of this application.
Customer Number
Email Address
Add Email
Remove Email
Application Information:
Title of the Invention
Attorney Docket Number
Small Entity Status Claimed
Application Type
Subject Matter
Suggested Class (if any)
Sub Class (if any)
Suggested Technology Center (if any)
Total Number of Drawing Sheets (if any)
EFS Web 2.2.3
Suggested Figure for Publication (if any)
PTO/SB/14 (11-08)
Approved for use through 01/31/2014. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number.
Application Data Sheet 37 CFR 1.76
Attorney Docket Number
Application Number
Title of Invention
Publication Information:
Request Early Publication (Fee required at time of Request 37 CFR 1.219)
Request Not to Publish.
I hereby request that the attached application not be published under 35 U.S.
C. 122(b) and certify that the invention disclosed in the attached application has not and will not be the subject of
an application filed in another country, or under a multilateral international agreement, that requires publication at
eighteen months after filing.
Representative Information:
Representative information should be provided for all practitioners having a power of attorney in the application. Providing
this information in the Application Data Sheet does not constitute a power of attorney in the application (see 37 CFR 1.32).
Enter either Customer Number or complete the Representative Name section below. If both sections
are completed the Customer Number will be used for the Representative Information during processing.
Please Select One:
Customer Number
US Patent Practitioner
Limited Recognition (37 CFR 11.9)
Customer Number
Domestic Benefit/National Stage Information:
This section allows for the applicant to either claim benefit under 35 U.S.C. 119(e), 120, 121, or 365(c) or indicate National Stage
entry from a PCT application. Providing this information in the application data sheet constitutes the specific reference required by
35 U.S.C. 119(e) or 120, and 37 CFR 1.78(a)(2) or CFR 1.78(a)(4), and need not otherwise be made part of the specification.
Prior Application Status
Application Number
Remove
Continuity Type
Prior Application Number
Filing Date (YYYY-MM-DD)
Additional Domestic Benefit/National Stage Data may be generated within this form
by selecting the Add button.
Foreign Priority Information:
This section allows for the applicant to claim benefit of foreign priority and to identify any prior foreign application for which priority is
not claimed. Providing this information in the application data sheet constitutes the claim for priority as required by 35 U.S.C. 119(b)
and 37 CFR 1.55(a).
Remove
Application Number
Countryi
Parent Filing Date (YYYY-MM-DD)
Priority Claimed
Yes
No
Additional Foreign Priority Data may be generated within this form by selecting the
Add button.
Assignee Information:
Providing this information in the application data sheet does not substitute for compliance with any requirement of part 3 of Title 37
of the CFR to have an assignment recorded in the Office.
Assignee 1
EFS Web 2.2.3
PTO/SB/14 (11-08)
Approved for use through 01/31/2014. OMB 0651-0032
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it contains a valid OMB control number.
Application Data Sheet 37 CFR 1.76
Attorney Docket Number
Application Number
Title of Invention
If the Assignee is an Organization check here.
Prefix
Given Name
Middle Name
Family Name
Suffix
Mailing Address Information:
Address 1
Address 2
City
State/Province
Countryi
Postal Code
Phone Number
Fax Number
Email Address
Additional Assignee Data may be generated within this form by selecting the Add
button.
Signature:
A signature of the applicant or representative is required in accordance with 37 CFR 1.33 and 10.18. Please see 37
CFR 1.4(d) for the form of the signature.
Signature
First Name
Date (YYYY-MM-DD)
Last Name
Registration Number
This collection of information is required by 37 CFR 1.76. The information is required to obtain or retain a benefit by the public which
is to file (and by the USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.14. This
collection is estimated to take 23 minutes to complete, including gathering, preparing, and submitting the completed application data
sheet form to the USPTO. Time will vary depending upon the individual case. Any comments on the amount of time you require to
complete this form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and
Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR
COMPLETED FORMS TO THIS ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.
EFS Web 2.2.3
Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with your submission of the attached form related to
a patent application or patent. Accordingly, pursuant to the requirements of the Act, please be advised that: (1) the general authority for the collection
of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which the information is
used by the U.S. Patent and Trademark Office is to process and/or examine your submission related to a patent application or patent. If you do not
furnish the requested information, the U.S. Patent and Trademark Office may not be able to process and/or examine your submission, which may
result in termination of proceedings or abandonment of the application or expiration of the patent.
The information provided by you in this form will be subject to the following routine uses:
1.
The information on this form will be treated confidentially to the extent allowed under the Freedom of Information Act (5 U.S.C. 552)
and the Privacy Act (5 U.S.C. 552a). Records from this system of records may be disclosed to the Department of Justice to determine
whether the Freedom of Information Act requires disclosure of these records.
2.
A record from this system of records may be disclosed, as a routine use, in the course of presenting evidence to a court, magistrate, or
administrative tribunal, including disclosures to opposing counsel in the course of settlement negotiations.
3.
A record in this system of records may be disclosed, as a routine use, to a Member of Congress submitting a request involving an
individual, to whom the record pertains, when the individual has requested assistance from the Member with respect to the subject matter of
the record.
4.
A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency having need for the information in
order to perform a contract. Recipients of information shall be required to comply with the requirements of the Privacy Act of 1974, as
amended, pursuant to 5 U.S.C. 552a(m).
5.
A record related to an International Application filed under the Patent Cooperation Treaty in this system of records may be disclosed,
as a routine use, to the International Bureau of the World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.
6.
A record in this system of records may be disclosed, as a routine use, to another federal agency for purposes of National Security
review (35 U.S.C. 181) and for review pursuant to the Atomic Energy Act (42 U.S.C. 218(c)).
7.
A record from this system of records may be disclosed, as a routine use, to the Administrator, General Services, or his/her designee,
during an inspection of records conducted by GSA as part of that agency's responsibility to recommend improvements in records
management practices and programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure shall be made in accordance with the
GSA regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or Commerce) directive. Such
disclosure shall not be used to make determinations about individuals.
8.
A record from this system of records may be disclosed, as a routine use, to the public after either publication of the application pursuant
to 35 U.S.C. 122(b) or issuance of a patent pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37
CFR 1.14, as a routine use, to the public if the record was filed in an application which became abandoned or in which the proceedings were
terminated and which application is referenced by either a published application, an application open to public inspections or an issued
patent.
9.
A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law enforcement agency, if the
USPTO becomes aware of a violation or potential violation of law or regulation.
EFS Web 2.2.3