Form PTO 2030 PTO 2030 Application for Public User ID

LAST NAME: (TO BE COMPLETED BY STAFF MEMBER)

USER ID NUMBER:

U.S. PATENT AND TRADEMARK OFFICE
PUBLIC SEARCH FACILITIES
APPLICATION FOR PUBLIC USER ID
ACKNOWLEDGEMENT

In order to be issued a User Pass which will permit access to the Public Search Facilities and track use of the facilities and
services, it is necessary to execute the following acknowledgement.
I acknowledge that the use of the Patent and Trademark Office search facilities is a privilege extended to
the public. By accepting the User ID and the entitlements thereunder, I agree to comply with, and be
bound by, all Patent and Trademark rules and regulations governing the use of Patent and Trademark
collections, services, facilities, reading rooms, and other premises of the Patent and Trademark Office. I
have received and read, “Conduct on Patent and Trademark Premises”.
Date: _______________________________

Signature:_______________________________________________

NAME: (PLEASE PRINT) _______________________________________________________________

ADDRESS:

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

TELEPHONE: (Home)__________________________________(Work)___________________________________________
FOR STAFF USE ONLY
Form of Identification Submitted:

Identification Card Number:

______________________________________________

_____________________________________________________

Restrictions (If Any:)

Paperwork Reduction Act and Privacy Act Statement
This collection of information is authorized by 5 U.S.C. 301, 35 U.S.C. 41(i)(1), 44 U.S.C. 3101, and 18 U.S.C. 2071 and will
primarily be used by the public to apply for (and by the USPTO to issue) Public User IDs. The information on this form will
be treated confidentially to the extent allowed under the Freedom of Information Act (FOIA) and the Privacy Act. When you
apply for a Public User ID, you must supply your name, address, signature, and a government-issued picture ID. Submission
of this information is voluntary; however, if you do not provide this information you will not be issued a Public User ID and
may not use the public facilities of the USPTO. Routine uses of this information you supply include disclosure to law
enforcement authorities, to your employer, or to organizations with which you claim affiliation. This information may be used
to retrieve documents that have been removed from the USPTO facilities and not returned. This information may also be
disclosed to Federal, state, or local agencies in support of their statutory or regulatory mission or enforcement duties; to a
court, magistrate, or administrative tribunal; to members of Congress or their staffs responding to requests from their
constituents; to the Department of Justice in connection with a FOIA request; to a contractor in the performance of their
duties; to the Office of Personnel Management for personnel studies; and to the General Services Administration in
connection with their responsibilities. This form is estimated to take five minutes to complete, including gathering, preparing,
and submitting the information to the USPTO and reading “Conduct on Patent and Trademark Premises.” 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
Manager of the Public Search Facilities, USPTO, P.O. Box 1450, Alexandria, VA 22313-1450.
PTO Form 2030 (Rev. 01/06). Approved for use through 06/30/2009. OMB 0651-0041 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.