Information Collection

Client Intake Form

IC 240440 under ICR 202001-0651-011 · OMB 0651-0082.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0082 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PTO 451 Client Intake Form	Form
PTO 451 Pro Bono Client Intake Form Client Intake Form PTO 451 20200610.pdf cla.formstack.com/forms/cla_financial_screening__application_copy	Form

IC Title:

Client Intake Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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 451	Pro Bono Client Intake Form	Client Intake Form PTO 451 20200610.pdf	https://cla.formstack.com/forms/cla_financial_screening__application_copy	Yes	Yes	Fillable Fileable

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,026

Number of Respondents for Small Entity: 1,026

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,026	1,026
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

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.