Current version of Form PTO/SB/66

Doc Code:

PTO/SB/66 (10-05)
Approved for use through 04/30/2009. OMB 0651-0016
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.

PETITION TO ACCEPT UNINTENTIONALLY DELAYED PAYMENT OF
MAINTENANCE FEE IN AN EXPIRED PATENT (37 CFR 1.378(c))

Docket Number (Optional)

Mail to: Mail Stop Petition
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450
Fax: (571) 273-8300
NOTE: If information or assistance is needed in completing this form, please contact Petitions Information
at (571) 272-3282.
Patent No. ____________________________ Application Number _______________________________
Issue Date ___________________________ Filing Date ______________________________________
CAUTION:

Maintenance fee (and surcharge, if any) payment must correctly identify: (1) the patent
number (or reissue patent number, if a reissue) and (2) the application number of the
actual U.S. application (or reissue application) leading to issuance of that patent to
ensure the fee(s) is/are associated with the correct patent. 37 CFR 1.366(c) and (d).

Also complete the following information, if applicable
The above - identified patent:
is a reissue of original Patent No. __________________, original issue date
original application number
,
original filing date ______________________.

resulted from the entry into the U.S. under 35 U.S.C. 371 of international
application ______________________________ filed on

;

.

CERTIFICATE OF MAILING (37 CFR 1.8(a))
I hereby certify that this paper (along with any paper referred to as being attached or enclosed) is being deposited with
the United States Postal Service on the date shown below with sufficient postage as first class mail in an envelope
addressed to Mail Stop Petition, Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450, or facsimile
transmitted to the U.S. Patent and Trademark Office on the date shown below.

__________________________
Date

_______________________________________________________________
Signature

_______________________________________________
Typed or printed name of person signing Certificate

[Page 1 of 3]
This collection of information is required by 37 CFR 1.378(c). 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 1.11 and 1.14. This collection is estimated to take 1 hour 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 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS
ADDRESS. SEND TO: Mail Stop Petition, Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.

If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

PTO/SB/66 (10-05)
Approved for use through 04/30/2009. OMB 0651-0016
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.

Doc Code:

1.

SMALL ENTITY
Patentee claims, or has previously claimed, small entity status. See 37 CFR 1.27.

2.

LOSS OF ENTITLEMENT TO SMALL ENTITY STATUS
Patentee is no longer entitled to small entity status. See 37 CFR 1.27(g).

3.

MAINTENANCE FEE (37 CFR 1.20(e)-(g))

The appropriate maintenance fee must be submitted with this petition, unless it was paid earlier.

NOT Small Entity
Amount

Fee

Small Entity
(Code)

Amount

Fee

(Code)

$ ________

3 1/2 yr fee

(1551)

$ _______

3 1/2 yr fee

(2551)

$ ________

7 1/2 yr fee

(1552)

$ _______

7 1/2 yr fee

(2552)

$ ________

11 1/2 yr fee

(1553)

$ _______

11 1/2 yr fee

(2553)

MAINTENANCE FEE BEING SUBMITTED $_________________

4.

SURCHARGE
The surcharge required by 37 CFR 1.20(i)(2) of $ ______________ (Fee Code 1558) must be paid as a condition
of accepting unintentionally delayed payment of the maintenance fee.
SURCHARGE BEING SUBMITTED $____________

5.

MANNER OF PAYMENT
Enclosed is a check for the sum of $__________________________.
Please charge Deposit Account No._____________________ the sum of $______________. A duplicate
copy of this authorization is attached.
Payment by credit card. Form PTO-2038 is attached.

6.

AUTHORIZATION TO CHARGE ANY FEE DEFICIENCY
The Director is hereby authorized to charge any maintenance fee, surcharge or petition
deficiency to Deposit Account No._______________. A duplicate copy of this authorization is attached.

[Page 2 of 3]

Doc Code:

PTO/SB/66 (10-05)
Approved for use through 04/30/2009. OMB 0651-0016
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

7. OVERPAYMENT
As to any overpayment made please
Credit to Deposit Account No.________________.
OR
Send refund check.

WARNING:
Petitioner/applicant is cautioned to avoid submitting personal information in documents filed in a patent application that may
contribute to identity theft. Personal information such as social security numbers, bank account numbers, or credit card
numbers (other than a check or credit card authorization form PTO-2038 submitted for payment purposes) is never required by
the USPTO to support a petition or an application. If this type of personal information is included in documents submitted to
the USPTO, petitioners/applicants should consider redacting such personal information from the documents before submitting
them to the USPTO. Petitioner/applicant is advised that the record of a patent application is available to the public after
publication of the application (unless a non-publication request in compliance with 37 CFR 1.213(a) is made in the application)
or issuance of a patent. Furthermore, the record from an abandoned application may also be available to the public if the
application is referenced in a published application or an issued patent (see 37 CFR 1.14). Checks and credit card
authorization forms PTO-2038 submitted for payment purposes are not retained in the application file and therefore are not
publicly available.
8. STATEMENT
The delay in payment of the maintenance fee to this patent was unintentional.
9. PETITIONER(S) REQUEST THAT THE DELAYED PAYMENT OF THE MAINTENANCE FEE BE
ACCEPTED AND THE PATENT REINSTATED.
_______________________________________________________________________

_______________________________

Signature(s) of Petitioner(s)

________________________________________________________________
Typed or printed name(s)

Date

___________________________
Registration Number, if applicable

________________________________________________________________
Telephone Number
_____________________________________________________________________________________________
Address
__________________________________________________________________________________________________________

Address
37 CFR 1.378(d) states: “Any petition under this section must be signed by an attorney or agent
registered to practice before the Patent and Trademark Office, or by the patentee, the assignee,
or other party in interest.”

ENCLOSURES:
Maintenance Fee payment
Surcharge under 37 CFR 1.20(i)(2) (fee for filing the maintenance fee petition)
_______________________________________________________________________________________________

[Page 3 of 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.

2.
3.

4.

5.
6.
7.

8.

9.

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.
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.
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.
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).
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.
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)).
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.
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 inspection or an
issued patent.
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.