Information Collection

Assignment Cover Sheet

IC 212233 under ICR 201709-0651-003 · OMB 0651-0075.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0075 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PTO 1595 Recordation Form Cover Sheet Assignment Cover Sheet	Form and Instruction
PTO 1595 Recordation Form Cover Sheet PTO 1595.pdf	Form and Instruction

IC Title:

Assignment Cover Sheet

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 3.11 37 CFR 3.24 37 CFR 3.26 37 CFR 3.28

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 and Instruction	PTO 1595				Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 1

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 98 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5	-195	200
Annual IC Time Burden (Hours)	3	-97	100
Annual IC Cost Burden (Dollars)	30	-38,892	38,922

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.

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