DOE F-2000.4 Record of Invention

DOE F 2000.4
(12-84)

U.S. DEPARTMENT OF ENERGY
OFFICE OF ASSISTANT GENERAL COUNSEL FOR PATENTS

(Previously Form GC-213)

OMB Approval
No. 1910-0800

DOE Case No.

RECORD OF INVENTION

This Record of Invention is an important legal document and proper care in its early and complete preparation
will save important time and inconvenience in the future. The instructions* on the back should be read carefully
before filling in the data.
A. Inventor: 1. Name(s):

3.

2. Title or Position:

Employed by:

4.

Permanent Address:

B. Title of Invention (1 *) :

C. Description of Invention (2 *):

D. Dates and Places of Inventions:
1.

Conception by inventor (3 *)

At

2.

First Sketch or Drawing

At

In Workbook

Page

3.

First Written Description

At

In Workbook

Page

4.

Disclosure to Others (4 *)

At

a.

19

At

b.

19

At

5.

Completion of Model or Full Size Device

6.

First Test or Operation of Invention

At
At

E.

Results of Tests and Extent of Use of Invention (5 *)

F.

Names of all Persons Having Knowledge of Facts Stated Under D.
and E.:

G.

Pertinent Records (6 *):

H.

Other Closely Related Publications, Patents, and Patent
Applications (7 *):

J.

Licenses or Assignments:

I.

K.

Rights of U.S. Government:

Contracts Involved:

Contract No.:

Contractor and Address

Type of Contract:
Unclassified

L.

Signature of Witness:

Date:

Date:

Restricted

Confidential

Signature of Inventor(s):

Date:

Date:

Forwarded by (8 *):

(OVER)

Secret

INSTRUCTIONS
1.* The title of the invention should indicate briefly the name of the article, device or type of
machine, material, composition, method, or process.
2.* The description of the invention may be brief, provided reference is made to detailed
specifications and drawings, which should be identified by origin, file numbers, and dates.
Copies should be attached to this Report. At the end of the description there should be
included a brief statement of what is claimed as new and patentable.
3.* Give the earliest date on which, and the place where, the invention suggested itself, even
though it was not completely in mind. If the invention comprises several different inventive
ideas, give the conception dates of each part of the invention separately, taking care to
identify each part clearly in the description of the invention.
4.* Disclosure to others should be by written description or by sketches and should be
authenticated in writing by two competent persons as follows:“Disclosed to and understood
By me this
19
.
(s)
Authentication of disclosure in workbooks is preferred.

.”

5.* State whether or not the invention was found to be operative, and the degree of success
attained at each test of the model or full-sized device. In stating the extent of use of the
invention, separate“use by the Government”from“commercial use.”
6.* List prior reports having a bearing on the problem to which the invention refers, giving origin,
file numbers, and dates.
7.* List all patents by number, date of grant, and title; list all applications for patents by filing
dates, serial number, and title.
8.* In forwarding the Record, an opinion should be given as to whether or not an application for
a patent should be filed.
N.B.If the information submitted on this Record of Invention warrants a classification, the form
should be appropriately classified.