Form PTO/SB/66 Petition to Accept Unintentionally Delayed Payment of Ma

PTO/SB/66 (03-09)
Approved for use through 03/31/2012. 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 1.89(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 main 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, Virginia 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, Virginia 22313-1450
If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

PTO/SB/66 (03-09)
Approved for use through 03/31/2012. 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

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

Small Entity

Fee

(Code)

$

3 ½ yr fee

(1551)

$

7 ½ yr fee

$

11 ½ yr fee

Amount

Fee

(Code)

$

3 ½ yr fee

(2551)

(1552)

$

7 ½ yr fee

(2552)

(1553)

$

11 ½ 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 a maintenance fee.
SURCHARGE FEE BEING SUBMITTED $
5. MANNER OF PAYMENT
Enclosed is a check for the sum of $
Please charge Deposit Account No.

the sum of $

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.

[Page 2 of 3]

PTO/SB/66 (03-09)
Approved for use through 03/31/2012. 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)

Date

Typed or printed name(s)

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. 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.
2. 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.
3. 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.
4. 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).
5. 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.
6. 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)).
7. 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.
8. 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.
9. 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.