This collection of informatio n is required by 37 CFR 1.133. The information is required to obtain or retain a benefit by the public which is to file (and by the USP TO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This coll ection is estimated to take 2 4 minutes to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depen ding upon the individual case. Any comments on the amount of time you require to complete th is form and/or suggestions for reducing this burden, should be sent to the Chief Information Officer, U.S. Patent and Tradema rk Office, U.S. Department of Commerce, P.O. Box 14 50, Alexandria, VA 22313 - 1450. DO NOT SEND FEES OR C OMPLETED FORMS TO THIS ADDRE SS. If you need assistance in completing the form, call 1 - 800 - PTO - 9199 and select option 2. Applicant Initiated Interview Request Form Application No.: First Named Applicant: Examiner: Art Unit: Status of Application: Tentative Participants: (1) (2) (3) (4) Proposed D ate of Interview: Proposed Time: (AMPM) Type of Interview Requested: (1)[ ] Telephonic (2)[ ] Personal (3)[ ] Video Conference Exhibit To Be Shown or Demonstrated: [ ] YES [ ] NO If yes, provide bri ef description: Issues To Be Discussed Issues Claims/ Prior Discussed Agreed Not Agreed (Rej., Obj., etc) Fig. #s Art (1) [ ] [ ] [ ] (2) [ ] [ ] [ ] (3) [ ] [ ] [ ] (4) [ ] [ ] [ ] [ ] Continuation Sheet Attached [ ] Proposed Amendment or Arguments Attached Brief Description of Arguments to be Presented: An interview was conducted on the above - identified applicati on on NOTE : This form should be completed and filed by applicant in advance of the interview (see MPEP 247 713.01). If this form is signed by a registered practitioner not of record, the Office will accept this as an indication that he or she is authorized to conduct an interview on behalf of the principal (37 CFR 1.32(a)(3)) pursuant to 37 CFR 1.34 . T his is not a power of attorney t o any above named practitioner. See the Instruction Sheet for this form, which is incorporated by refer ence. By signing this form, applicant or practitioner is certifying that he or she has read the Instruction Sheet. After the interview is conducted, applicant is advised to file a statement of the substance of this interview (37 CFR 1.133(b)) as soon as po ssible. This application will not be delayed from issue because of itten record of this interview. PTOL-413A (07-16) Approved for use through /3/20. OMB 0651-0031 U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE Examiner/SPE Signature Typed/Printed Name of Applicant or Representative Registration Number, if applicable Doc Code: M865 or FAI.REQ.INTV Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com PTOL-413A (08-10) Approved for use through /3/20. OMB 0651-0031 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 displays a valid OMB control number. 1.If this form is signed by a registered practitioner not of record, the authority tosubmit the Applicant Initiated Interview Request Form is pursuant to limitedauthority to act in a representative capacity under 37 CFR 1.34 and furtherproof of authority to act in a representative capacity may berequired. See 37 CFR 1.34. The Office will accept the signed form as an indication that the registeredpractitioner not of record is authorized to conduct an interview on behalf of theprincipal in pursuant to 37 CFR 1.34. For more information, see the 223Conducting an Interview with a RegisteredPractitioner Acting in a Representative Capacity224 notice which is available onthe USPTO Web site at: http://www.uspto.gov/patents/law/notices/2010.jsp. 2.This is not a power of attorney to any named practitioner. Accordingly, anyregistered practitioner not of record named on the form does not haveauthority to sign a request to change the correspondence address, a requestfor express abandonment, a disclaimer, a power of attorney, or otherdocument requiring the signature of the applicant, assignee of the entireinterest or an attorney of record. If appropriate, a separate power of attorneyto the named practitioner should be executed and filed in the US Patent andTrademark Office. 3.Any interview concerning an unpublished application under 35 U.S.C. 247 122(b)with a registered practitioner not of record who obtains authorization throughuse of the PTOL-413A will be conducted based on the information and filessupplied by the practitioner in view of the confidentiality requirements of35 U.S.C. 247 122(a). Instruction Sheet for: APPLICANT INITIATED INTERVIEW REQUEST FORM (Not to be Submitted to the USPTO) Doc Code: M865 or FAI.REQ.INTV American LegalNet, Inc. www.FormsWorkFlow.com 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 theFreedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records fromthis system of records may be disclosed to the Department of Justice to determine whetherdisclosure of these records is required by the Freedom of Information Act.2.A record from this system of records may be disclosed, as a routine use, in the course ofpresenting evidence to a court, magistrate, or administrative tribunal, including disclosures toopposing 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 Congresssubmitting a request involving an individual, to whom the record pertains, when the individualhas 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 theAgency having need for the information in order to perform a contract. Recipients of informationshall 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 thissystem of records may be disclosed, as a routine use, to the International Bureau of the WorldIntellectual 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 agencyfor purposes of National Security review (35 U.S.C. 181) and for review pursuant to the AtomicEnergy 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 aspractices and programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure shall bemade 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 usedto make determinations about individuals.8.A record from this system of records may be disclosed, as a routine use, to the public aftereither publication of the application pursuant to 35 U.S.C. 122(