Information Collection

Certificate Self-Recovery Form

IC 187782 under ICR 201111-0651-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Certificate Self-Recovery Form	Form
Certificate Self-Recovery Form onlinerecoverysample.pdf sas.uspto.gov/ptosas	Form

IC Title:

Certificate Self-Recovery Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	None	Certificate Self-Recovery Form	onlinerecoverysample.pdf	https://sas.uspto.gov/ptosas	Yes	Yes	Fillable Fileable Signable

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: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,063	2,063
Annual IC Time Burden (Hours)	-351	351
Annual IC Cost Burden (Dollars)	0	0

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.