Certificate Action Form (and Subscriber Agreement)

Public Key Infrastructure (PKI)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form PTO-2042 Certificate Action Form (and Subscriber Agreement) Form
PKI_Subscriber_Agreement__Dec09.pdf www.uspto.gov/patents/process/status/private_pair/PKI_Subscriber_Agreement__Dec09.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

Information Collection (IC) Details

IC Title:	Certificate Action Form (and 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:

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			PKI_Subscriber_Agreement__Dec09.pdf	http://www.uspto.gov/patents/process/status/private_pair/PKI_Subscriber_Agreement__Dec09.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: 80 FR 32

Number of Respondents: 4,500	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 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,500	0	4,500
Annual IC Time Burden (Hours)	2,250	0	2,250
Annual IC Cost Burden (Dollars)	11,205	180	11,025

Documents for IC

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.