PTO/SB/17 (0313) Approved for use through 04/30/2017. OMB 06510032 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 FEE TRANSMITTAL Applicant asserts small entity status. See 37 CFR 1.27. Applicant certifies micro entity status. See 37 CFR 1.29. Form PTO/SB/15A or B or equivalent must either be enclosed or have been submitted previously. TOTAL AMOUNT OF PAYMENT ($) Complete if known Filing Date First Named Inventor Examiner Name Art Unit Practitioner Docket No. Application Number METHOD OF PAYMENT (check all that apply) Check Credit Card Money Order None Other (please identify): ___________________________________________ Deposit Account Deposit Account Number: _______________________ Deposit Account Name: ______________________ For the aboveidentified deposit account, the Director is hereby authorized to (check all that apply): Charge fee(s) indicated below Charge fee(s) indicated below, except for the filing fee Charge any additional fee(s) or underpayment of fee(s) Credit any overpayment of fee(s) under 37 CFR 1.16 and 1.17 WARNING: Information on this form may become public. Credit card information should not be included on this form. Provide credit card information and authorization on PTO2038. FEE CALCULATION 1. BASIC FILING, SEARCH, AND EXAMINATION FEES (U = undiscounted fee; S = small entity fee; M = micro entity fee) Application Type Utility Design Plant Reissue Provisional U ($) 280 180 180 280 260 FILING FEES S ($) 140* 90 90 140 130 M ($) 70 45 45 70 65 U ($) 600 120 380 600 0 SEARCH FEES S ($) 300 60 190 300 0 M ($) 150 30 95 150 0 EXAMINATION FEES U ($) S ($) M ($) 720 360 180 460 230 115 580 290 145 2,160 1,080 540 0 0 0 Fees Paid ($) * The $140 small entity status filing fee for a utility application is further reduced to $70 for a small entity status applicant who files the application via EFSWeb. 2. EXCESS CLAIM FEES Undiscounted Fee ($) Fee Description Each claim over 20 (including Reissues) 80 Each independent claim over 3 (including Reissues) 420 Multiple dependent claims 780 Extra Claims Fee ($) Fee Paid ($) Total Claims __________ 20 or HP = __________ x __________ = __________ HP = highest number of total claims paid for, if greater than 20. Indep. Claims Extra Claims Fee ($) Fee Paid ($) __________ 3 or HP = __________ x __________ = __________ HP = highest number of independent claims paid for, if greater than 3. 3. APPLICATION SIZE FEE If the specification and drawings exceed 100 sheets of paper (excluding electronically filed sequence or computer listings under 37 CFR 1.52(e)), the application size fee due is $400 ($200 for small entity) ($100 for micro entity) for each additional 50 sheets or fraction thereof. See 35 U.S.C. 41(a)(1)(G) and 37 CFR 1.16(s). Extra Sheets Number of each additional 50 or fraction thereof Fee ($) Fee Paid ($) Total Sheets __________ 100 = __________ / 50 = __________ (round up to a whole number) x __________ = __________ 4. OTHER FEE(S) NonEnglish specification, $130 fee (no small or micro entity discount) Nonelectronic filing fee under 37 CFR 1.16(t) for a utility application, $400 fee ($200 small or micro entity) Other (e.g., late filing surcharge): _______________________________________________________________________ SUBMITTED BY Signature Name (Print/Type) Registration No. (Attorney/Agent) Telephone Date Fees Paid ($) __________ __________ __________ Small Entity Fee ($) 40 210 390 Micro Entity Fee ($) 20 105 195 Multiple Dependent Claims Fee ($) Fee Paid ($) __________ __________ This collection of information is required by 37 CFR 1.136. 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 30 minutes to complete, including gathering, preparing, and submitting the completed application 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 223131450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 223131450. If you need assistance in completing the form, call 1800PTO9199 and select option 2. 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 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 disclosure 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 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