Legal Collections Package

DOE F 482.3
(05/18)

OMB Control No. 1910-0800
Expiration Date: XX/XX/XXXX

DEPARTMENT OF ENERGY
NONEXCLUSIVE PATENT LICENSE APPLICATION

It is the policy of the U.S. Department of Energy (DOE) to accord licensed on DOE-owned
patents applications in appropriate circumstances to applicants with satisfactory plans for
development and/or marketing of the invention. 37 CFR Part 404, Licensing of Government
Owned Inventions, provides terms, conditions, and procedures for the accord of patent licenses,
both nonexclusive, on DOE-owned patents and patent applications.
An application for a nonexclusive license should set forth the following, and, in addition, any
other information that applicant deems would be of importance to show that the accord of a nonexclusive license is in the public interest. The application must be accompanied by a processing
fee of $25.00. The check or money order should be made payable to the U.S. Department of
Energy.
Applications should be addressed to:
Assistant General Counsel
for Technology Transfer
and Intellectual Property
1000 Independence Avenue, S.W.
Washington, D.C. 20585
INFORMATION REQUIRED:
1.

Identification of Applicant
(a)

Name:

(b)

Address:

(c)

Citizenship and State of Incorporation:

(d)

Name, title, and telephone number of representative of applicant with whom
negotiations are to be considered:

2.

Identification of Invention
(a)

Patent Number of Patent Application Serial Number:

(b)

Title:

3.

Nature and type of applicant’s business, including identification of products or services
which applicant has successfully commercialized, and including approximate number of
applicant’s employees:

4.

Applicant’s status, if applicable, as a small business, as defined at section 2 of Pub. L. 85535 (15 USC 632) and implementing regulations of the Small Business Administration:

5.

Identification of source of information concerning the availability for license of the
invention:

6.

In support of this application, please submit, as an appendix hereto, a detailed description
of applicant’s plan for development and/or marketing of the invention, which should
include:
(a)

A statement as to applicant’s intention to fulfill the plan, including applicant’s
manufacturing, marketing, financial, and technical capability to fulfill the plan;.

(b)

A statement of the time, nature, and amount of anticipated investment of capital
and other resources which applicant believes will be necessary to bring the
invention to practical application;

(c)

A statement of the field or fields of use for which applicant intends to practice the
invention; and

DOE F 482.3
(05/18)

(d)

OMB Control No. 1910-0800
Expiration Date: XX/XX/XXXX

A statement of the geographic areas in which applicant intends to manufacture,
use, or sell any products embodying the invention or produced through the use of
the invention.

(Signature)

(Name and title of authorized representative)

Date:

Enclosure: Check in the amount of $25.00
Payable to: United Stated Department of Energy

Public reporting burden for this collection of information is estimated to average 7.7 hours per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-23,
Paperwork Reduction Project OMB control number 1910-0800, U.S. Department of Energy, 1000 Independence Ave SW,
Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project OMB
control number 1910-0800, Washington, DC 20503.