Form G261-1 Pro Bono Survey Questions

Pro Bono Patent Program: QUARTERLY METRIC REPORTING QUESTIONNAIRE - ... Page 2 of 3

OMB No. 0651-0080

Expires 08/31/2018

Pro Bono Patent Program

Quarterly Metrics Reporting Questionnaire

Basic Information

[Section 1 of 9]

Name of Person Reporting Metrics*

First Name Last Name

Email*

1. What is the name of your USPTO regional pro bono program?*

2. Reporting Year*

3. Reporting Period*

First Quarter ^

4. Number of potential applicants who requested services from your program this quarter?*

5. What U.S. States does your program serve?*

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware

Florida

Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland

Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

New Hampshire New Jersey New Mexico New York

North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas

Utah Vermont Virginia Washington

Washington, D.C. West Virginia Wisconsin Wyoming

[Check all that apply]

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Progress

Referral Sources

[Section 2 of 9]

6. Number of applicants applying from each U.S. State?

[e.g. CA = 35; NV = 6; HI = 2; AK = 1; etc.]

6. Number of applicants referred to your program by the Federal Circuit Bar?*

6. Number of applicants that came directly to your regional program?*

6. Number of applicants that came from another source?

6. If applicable, list other sources of referrals:

[e.g. from a law firm; law school; small business development center; etc.]

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Progress

11. Number of applicants completing and returning the financial screening application this quarter?

[Where regional program uses a financial screening application form]

12. Number of financial screenings approved this quarter?

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Progress

Invention Screening

[Section 4 of 9]

13. Number of invention screenings approved this quarter?

14. Total number of applications approved for placement with an attorney/agent this quarter?

Disqualifications

[Section 5 of 9]

15. Total number of applicants disqualified (for any reason)?

16. List reasons for disqualifications below:

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Placement Information

[Section 6 of 9]

17. Number of applicants placed with an attorney/agent this quarter*

[Providers include: law firms; in-house legal teams; solo attorneys; etc.]

18. Breakdown placements by state

[Use the applicant’s state as the state of placement, e.g., AL – 4; MS = 2.]

19. Number of applicants placed -- but cancelled – this quarter?

20. Cumulative backlog

[Total number of applicants approved for placement but not matched with an attorney/agent for legal services as of the end of this quarter]

Panel Attorney Information

[Section 7 of 9]

21. Total number of corporations and law firms agreeing to accept cases as of the last day of this quarter?

22. Total number of attorneys agreeing to accept cases as of the last day of this quarter?

[Total number of applicants approved for placement but not matched with an attorney/agent for legal services as of the end of this quarter]

23. Estimated number of hours donated by lawyer referral service panel attorneys serving in your program during this quarter?*

Patent Categories

[Section 8 of 9]

24. Number of provisional patent applications filed through the Program this quarter?

25. Number of non-provisional patent applications filed through the Program this quarter?

26. Number of design patent applications filed through the Program this quarter?

27. List the patent numbers for the patents that issued this quarter?

[Patent numbers are formatted X,XXX,XXX; do not list patent application numbers, which are formatted XX/XXX,XXX]

Program Financial Information

[Section 9 of 9]

To be completed twice a year for the period beginning January 1^st, ending June 30^th, and the period beginning July 1^st, ending December 31^st only if your program has an active Memorandum of Agreement with the USPTO.

28. Based on your current finances, as of today, what is the percentage of the total project cost (as listed in your current JPA) that your organization is able to cover?

29. What is the total number of donors who have made multi-year (calendar year) commitments or the number of donors who have donated for more than one year in the previous three years?

30. What is the total number of donors who have donated for the first time this calendar year?

31. What is the total number of donors who have donated to your program this calendar year?

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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. The data collected from this survey will be used for planning efforts to ensure that visits to the public search facility are productive and positive experiences. The responses will be aggregated. This collection of information is voluntary in accordance with E.O. 12862, "Setting Customer Service Standards." All repossess will remain confidential and are protected under the "Confidential Information Protection and Statistical Efficiency Act of 2002." This survey contains 31 questions and the USPTO estimates that it will take approximately 2 hours to complete this survey.

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^Progress

Submit Form

7/27/2016

https://cla.formstack.com/forms/patent_probono_q_reports