The applcaton data sheet s part of the provsonal or nonprovsonal applcaton for whch t s beng submtted. The followng form contans the bblographc data arranged n a format specfed by the Unted States Patent and Trademark Offce as outlned n 37 CFR 1.76. Ths document may be completed electroncally and submtted to the Offce n electronc format usng the Electronc Flng System (EFS) or the document may be prnted and ncluded n a paper fled applcaton. Secrecy Order 37 CFR 5.2 Portons or all of the applcaton assocated wth ths Applcaton Data Sheet may fall under a Secrecy Order pursuant to 37 CFR 5.2 (Paper flers only. Applcatons that fall under Secrecy Order may not be fled electroncally.) Inventor Informaton: Inventor 1 Legal Name Remove Prefx Gven Name Mddle Name Famly Name Suffx Resdence Informaton (Select One) US Resdency Non US Resdency Actve US Mltary Servce Cty State/Provnce Country of Resdence Malng Address of Inventor: Address 1 Address 2 Cty Postal Code Country State/Provnce All Inventors Must Be Lsted - Addtonal Inventor Informaton blocks may be generated wthn ths form by selectng the Add button. Add Correspondence Informaton: Enter ether Customer Number or complete the Correspondence Informaton secton below. For further nformaton see 37 CFR 1.33(a). An Address s beng provded for the correspondence Informaton of ths applcaton. Customer Number Emal Address Add Emal Remove Emal Applcaton Informaton: Ttle of the Inventon Applcaton Type Subject Matter Small Entty Status Clamed Total Number of Drawng Sheets (f any) Flng By Reference : Suggested Fgure for Publcaton (f any)
Only complete ths secton when flng an applcaton by reference under 35 U.S.C. 111(c) and 37 CFR 1.57(a). Do not complete ths secton f applcaton papers ncludng a specfcaton and any drawngs are beng fled. Any domestc beneft or foregn prorty nformaton must be provded n the approprate secton(s) below (.e., Domestc Beneft/Natonal Stage Informaton and Foregn Prorty Informaton ). For the purposes of a flng date under 37 CFR 1.53(b), the descrpton and any drawngs of the present applcaton are replaced by ths reference to the prevously fled applcaton, subject to condtons and requrements of 37 CFR 1.57(a). Applcaton number of the prevously fled applcaton Flng date (YYYY-MM-DD) Intellectual Property Authorty or Country Publcaton Informaton: Request Early Publcaton (Fee requred at tme of Request 37 CFR 1.219) Request Not to Publsh. I hereby request that the attached applcaton not be publshed under 35 U.S.C. 122(b) and certfy that the nventon dsclosed n the attached applcaton has not and wll not be the subject of an applcaton fled n another country, or under a multlateral nternatonal agreement, that requres publcaton at eghteen months after flng. Representatve Informaton: Representatve nformaton should be provded for all practtoners havng a power of attorney n the applcaton. Provdng ths nformaton n the Applcaton Data Sheet does not consttute a power of attorney n the applcaton (see 37 CFR 1.32). Ether enter Customer Number or complete the Representatve Name secton below. If both sectons are completed the customer Number wll be used for the Representatve Informaton durng processng. Please Select One: Customer Number Customer Number US Patent Practtoner Lmted Recognton (37 CFR 11.9) Domestc Beneft/Natonal Stage Informaton: Ths secton allows for the applcant to ether clam beneft under 35 U.S.C. 119(e), 120, 121, or 365(c) or ndcate Natonal Stage entry from a PCT applcaton. Provdng ths nformaton n the applcaton data sheet consttutes the specfc reference requred by 35 U.S.C. 119(e) or 120, and 37 CFR 1.78. When referrng to the current applcaton, please leave the applcaton number blank. Pror Applcaton Status Remove Contnuty Type Pror Flng Date (YYYY-MM-DD) Addtonal Domestc Beneft/Natonal Stage Data may be generated wthn ths form by selectng the Add button. Foregn Prorty Informaton:
Ths secton allows for the applcant to clam prorty to a foregn applcaton. Provdng ths nformaton n the applcaton data sheet consttutes the clam for prorty as requred by 35 U.S.C. 119(b) and 37 CFR 1.55(d). When prorty s clamed to a foregn applcaton that s elgble for retreval under the prorty document exchange program (PDX) the nformaton wll be used by the Offce to automatcally attempt retreval pursuant to 37 CFR 1.55(h)(1) and (2). Under the PDX program, applcant bears the ultmate responsblty for ensurng that a copy of the foregn applcaton s receved by the Offce from the partcpatng foregn ntellectual property offce, or a certfed copy of the foregn prorty applcaton s fled, wthn the tme perod specfed n 37 CFR 1.55(g)(1). Remove Country Flng Date (YYYY-MM-DD) Access Code (f applcable) Addtonal Foregn Prorty Data may be generated wthn ths form by selectng the Add button. Statement under 37 CFR 1.55 or 1.78 for AIA (Frst Inventor to Fle) Transton Applcatons Ths applcaton (1) clams prorty to or the beneft of an applcaton fled before March 16, 2013 and (2) also contans, or contaned at any tme, a clam to a clamed nventon that has an effectve flng date on or after March 16, 2013. NOTE: By provdng ths statement under 37 CFR 1.55 or 1.78, ths applcaton, wth a flng date on or after March 16, 2013, wll be examned under the frst nventor to fle provsons of the AIA. Authorzaton to Permt Access: Authorzaton to Permt Access to the Instant Applcaton by the Partcpatng Offces
If checked, the undersgned hereby grants the USPTO authorty to provde the European Patent Offce (EPO), the Japan Patent Offce (JPO), the Korean Intellectual Property Offce (KIPO), the World Intellectual Property Offce (WIPO), and any other ntellectual property offces n whch a foregn applcaton clamng prorty to the nstant patent applcaton s fled access to the nstant patent applcaton. See 37 CFR 1.14(c) and (h). Ths box should not be checked f the applcant does not wsh the EPO, JPO, KIPO, WIPO, or other ntellectual property offce n whch a foregn applcaton clamng prorty to the nstant patent applcaton s fled to have access to the nstant patent applcaton. In accordance wth 37 CFR 1.14(h)(3), access wll be provded to a copy of the nstant patent applcaton wth respect to: 1) the nstant patent applcaton-as-fled; 2) any foregn applcaton to whch the nstant patent applcaton clams prorty under 35 U.S.C. 119(a)-(d) f a copy of the foregn applcaton that satsfes the certfed copy requrement of 37 CFR 1.55 has been fled n the nstant patent applcaton; and 3) any U.S. applcaton-as-fled from whch beneft s sought n the nstant patent applcaton. In accordance wth 37 CFR 1.14(c), access may be provded to nformaton concernng the date o f flng ths Authorzaton. Applcant Informaton: Provdng assgnment nformaton n ths secton does not substtute for complance wth any requrement of part 3 of Ttle 37 of CFR to have an assgnment recorded by the Offce. Applcant 1 If the applcant s the nventor (or the remanng jont nventor or nventors under 37 CFR 1.45), ths secton should not be completed. The nformaton to be provded n ths secton s the name and address of the legal representatve who s the applcant under 37 CFR 1.43; or the name and address of the assgnee, person to whom the nventor s under an oblgaton to assgn the nventon, or person who otherwse shows suffcent propretary nterest n the matter who s the applcant under 37 CFR 1.46. If the applcant s an applcant under 37 CFR 1.46 (assgnee, person to whom the nventor s oblgated to assgn, or person who otherwse shows suffcent propretary nterest) together wth one or more jont nventors, then the jont nventor or nventors who are also the applcant should be dentfed n ths secton. Clear Assgnee Legal Representatve under 35 U.S.C. 117 Jont Inventor Person to whom the nventor s oblgated to assgn. Person who shows suffcent propretary nterest If applcant s the legal representatve, ndcate the authorty to fle the patent applcaton, the nventor s: Name of the Deceased or Legally Incapactated Inventor : If the Applcant s an Organzaton check here. Prefx Gven Name Mddle Name Famly Name Suffx
Malng Address Informaton For Applcant: Address 1 Address 2 Cty Country Phone Number Emal Address State/Provnce Postal Code Fax Number Addtonal Applcant Data may be generated wthn ths form by selectng the Add button. Assgnee Informaton ncludng Non-Applcant Assgnee Informaton: Provdng assgnment nformaton n ths secton does not substute for complance wth any requrement of part 3 of Ttle 37 of CFR to have an assgnment recorded by the Offce. Assgnee 1 Complete ths secton f assgnee nformaton, ncludng non-applcant assgnee nformaton, s desred to be ncluded on the patent applcaton publcaton. An assgnee-applcant dentfed n the "Applcant Informaton" secton wll appear on the patent applcaton publcaton as an applcant. For an assgnee-applcant, complete ths secton only f dentfcaton as an assgnee s also desred on the patent applcaton publcaton. If the Assgnee or Non-Applcant Assgnee s an Organzaton check here. Prefx Gven Name Mddle Name Famly Name Suffx Malng Address Informaton For Assgnee ncludng Non-Applcant Assgnee: Address 1 Address 2 Cty Country Phone Number Emal Address State/Provnce Postal Code Fax Number Addtonal Assgnee or Non-Applcant Assgnee Data may be generated wthn ths form by selectng the Add button.
Sgnature: NOTE: Ths form must be sgned n accordance wth 37 CFR 1.33. See 37 CFR 1.4 for sgnature requrements and certfcatons. Sgnature Date (YYYY-MM-DD) Frst Name Last Name Regstraton Number Addtonal Sgnature may be generated wthn ths form by selectng the Add button. Ths collecton of nformaton s requred by 37 CFR 1.76. The nformaton s requred to obtan or retan a beneft by the publc whch s to fle (and by the USPTO to process) an applcaton. Confdentalty s governed by 35 U.S.C. 122 and 37 CFR 1.14. Ths collecton s estmated to take 23 mnutes to complete, ncludng gatherng, preparng, and submttng the completed applcaton data sheet form to the USPTO. Tme wll vary dependng upon the ndvdual case. Any comments on the amount of tme you requre to complete ths form and/or suggestons for reducng ths burden, should be sent to the Chef Informaton Offcer, U.S. Patent and Trademark Offce, U.S. Department of Commerce, P.O. Box 1450, Alexandra, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Commssoner for Patents, P.O. Box 1450, Alexandra, VA 22313-1450.
Prvacy Act Statement The Prvacy Act of 1974 (P.L. 93-579) requres that you be gven certan nformaton n connecton wth your submsson of the attached form related to a patent applcaton or patent. Accordngly, pursuant to the requrements of the Act, please be advsed that: (1) the general authorty for the collecton of ths nformaton s 35 U.S.C. 2(b)(2); (2) furnshng of the nformaton solcted s voluntary; and (3) the prncpal purpose for whch the nformaton s used by the U.S. Patent and Trademark Offce s to process and/or examne your submsson related to a patent applcaton or patent. If you do not furnsh the requested nformaton, the U.S. Patent and Trademark Offce may not be able to process and/or examne your submsson, whch may result n termnaton of proceedngs or abandonment of the applcaton or expraton of the patent. The nformaton provded by you n ths form wll be subject to the followng routne uses: 1. The nformaton on ths form wll be treated confdentally to the extent allowed under the Freedom of Informaton Act (5 U.S.C. 552) and the Prvacy Act (5 U.S.C. 552a). Records from ths system of records may be dsclosed to the Department of Justce to determne whether the Freedom of Informaton Act requres dsclosure of these records. 2. A record from ths system of records may be dsclosed, as a routne use, n the course of presentng evdence to a court, magstrate, or admnstratve trbunal, ncludng dsclosures to opposng counsel n the course of settlement negotatons. 3. A record n ths system of records may be dsclosed, as a routne use, to a Member of Congress submttng a request nvolvng an ndvdual, to whom the record pertans, when the ndvdual has requested assstance from the Member wth respect to the subject matter of the record. 4. A record n ths system of records may be dsclosed, as a routne use, to a contractor of the Agency havng need for the nformaton n order to perform a contract. Recpents of nformaton shall be requred to comply wth the requrements of the Prvacy Act of 1974, as amended, pursuant to 5 U.S.C. 552a(m). 5. A record related to an Internatonal Applcaton fled under the Patent Cooperaton Treaty n ths system of records may be dsclosed, as a routne use, to the Internatonal Bureau of the World Intellectual Property Organzaton, pursuant to the Patent C o o p eraton Treaty. 6. A record n ths system of records may be dsclosed, as a routne use, to another federal agency for purposes of Natonal Securty revew (35 U.S.C. 181) and for revew pursuant to the Atomc Energy Act (42 U.S.C. 218(c)). 7. A record from ths system of records may be dsclosed, as a routne use, to the Admnstrator, General Servces, or hs/her desgnee, durng an nspecton of records conducted by GSA as part of that agency's responsblty to recommend mprovements n records management practces and programs, under authorty of 44 U.S.C. 2904 and 2906. Such dsclosure shall be made n accordance wth the GSA regulatons governng nspecton of records for ths purpose, and any other relevant (.e., GSA or Commerce) drectve. Such dsclosure shall not be used to make determnatons about ndvduals. 8. A record from ths system of records may be dsclosed, as a routne use, to the publc after ether publcaton of the applcaton pursuant to 35 U.S.C. 122(b) or ssuance of a patent pursuant to 35 U.S.C. 151. Further, a record may be dsclosed, subject to the lmtatons of 37 CFR 1.14, as a routne use, to the publc f the record was fled n an applcaton whch became abandoned or n whch the proceedngs were termnated and whch applcaton s referenced by ether a publshed applcaton, an applcaton open to publc nspectons or an ssued patent. 9. A record from ths system of records may be dsclosed, as a routne use, to a Federal, State, or local law enforcement agency, f the USPTO becomes aware of a volaton or potental volaton of law or regulaton.