Client Intake Form

Pro Bono Survey

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.