Information Collection

Certificate Action Form (including Subscriber Agreement)

IC 4770 under ICR 200901-0651-002 · OMB 0651-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0045 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PTO-2042 Certificate Action Form (including Subscriber Agreement)	Form
subscribersagreement.pdf www.uspto.gov/ebc/documents/subscribersagreement.pdf	Other-Agreement
instructions.pdf www.uspto.gov/ebc/documents/instructions.pdf	Instruction
PTO-2042 Certificate Action Form certificateactionform.pdf www.uspto.gov/ebc/documents/certificateactionform.pdf	Form

IC Title:

Certificate Action Form (including Subscriber Agreement)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 1.14

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PTO-2042	Certificate Action Form	certificateactionform.pdf	http://www.uspto.gov/ebc/documents/certificateactionform.pdf	Yes	No	Fillable Printable
Other-Agreement			subscribersagreement.pdf	http://www.uspto.gov/ebc/documents/subscribersagreement.pdf	Yes	No	Printable Only
Instruction			instructions.pdf	http://www.uspto.gov/ebc/documents/instructions.pdf	Yes	No	Printable Only

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records

Title: USPTO PKI Registration and Maintenance System

FR Citation: 65 FR 24178

Number of Respondents: 2,063

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,063	-2,063	4,126
Annual IC Time Burden (Hours)	1,032	-351	1,383
Annual IC Cost Burden (Dollars)	4,992	-8	5,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.