Information Collection

Certification and Request to Make Special Under the Law School Clinic Program

IC 218686 under ICR 202001-0651-007 · OMB 0651-0081.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0081 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PTO/SB/419 Certification and Request to Make Special Under the Law School Clinic Program	Form
0033 EFS web user page.mht.pdf efs.uspto.gov/EFSWebUIUnregistered/EFSWebUnregistered	Other-Website
PTO/SB/419 CERTIFICATION AND REQUEST TO MAKE SPECIAL UNDER THE LAW Law_School_Request_to_Make_Special_Form_FINAL.docx www.uspto.gov/learning-and-resources/ip-policy/public-information-about-practitioners/law-school-clinic-1	Form

IC Title:

Certification and Request to Make Special Under the Law School Clinic Program

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 11.16-17

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	PTO/SB/419	CERTIFICATION AND REQUEST TO MAKE SPECIAL UNDER THE LAW SCHOOL PROGRAM	Law_School_Request_to_Make_Special_Form_FINAL.docx	https://www.uspto.gov/learning-and-resources/ip-policy/public-information-about-practitioners/law-school-clinic-1	Yes	Yes	Fillable Fileable Signable
Other-Website			0033 EFS web user page.mht.pdf	https://efs.uspto.gov/EFSWebUIUnregistered/EFSWebUnregistered	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records

Title: Patent Application Files

FR Citation: 78 FR 19243

Number of Respondents: 2

Number of Respondents for Small Entity: 2

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2	-28	30
Annual IC Time Burden (Hours)	2	-28	30
Annual IC Cost Burden (Dollars)	7	-33	40

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.