PTO/SB/17 Fee Transmittal Form

PTO/SB/17 (10-08)
Approved for use through 09/30/2010. OMB 0651-0032
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

Doc Code:

Complete if Known

Effective on 12/08/2004.
Fees pursuant to the Consolidated Appropriations Act, 2005 (H.R. 4818).

Application Number

FEE TRANSMITTAL

Filing Date

For FY 2009

First Named Inventor
Examiner Name

Applicant claims small entity status. See 37 CFR 1.27
TOTAL AMOUNT OF PAYMENT

Art Unit

($)

Attorney Docket No.

METHOD OF PAYMENT (check all that apply)

Check

Credit Card

Deposit Account

Money Order

Other (please identify):______________________

None

Deposit Account Number:______________________

Deposit Account Name:______________________________________

For the above-identified deposit account, the Director is hereby authorized to: (check all that apply)
Charge fee(s) indicated below

Charge fee(s) indicated below, except for the filing fee

Charge any additional fee(s) or underpayments of fee(s)
under 37 CFR 1.16 and 1.17

Credit any overpayments

WARNING: Information on this form may become public. Credit card information should not be included on this form. Provide credit card
information and authorization on PTO-2038.

FEE CALCULATION
1. BASIC FILING, SEARCH, AND EXAMINATION FEES
FILING FEES
SEARCH FEES
Application Type

Small Entity
Fee ($)
Fee ($)

Small Entity
Fee ($)
Fee ($)

Utility
Design
Plant
Reissue
Provisional

330
220
220
330
220

540
100
330
540
0

165
110
110
165
110

270
50
165
270
0

2. EXCESS CLAIM FEES

EXAMINATION FEES
Fee ($)

220
140
170
650
0

Small Entity
Fee ($)

52
220
390

Each claim over 20 (including Reissues)
Each independent claim over 3 (including Reissues)
Multiple dependent claims
Total Claims
Extra Claims
Fee ($)
Fee Paid ($)
__________ - 20 or HP = ___________ x __________ = ___________
HP = highest number of total claims paid for, if greater than 20.

Indep. Claims
__________ - 3 or HP =

____________
____________
____________
____________
____________

110
70
85
325
0
Fee ($)

Fee Description

Extra Claims
Fee ($)
Fee Paid ($)
____________ x __________ = ___________

Fees Paid ($)

Small Entity
Fee ($)

26
110
195

Multiple Dependent Claims
Fee ($)
Fee Paid ($)
_________

___________

HP = highest number of independent claims paid for, if greater than 3.

3. APPLICATION SIZE FEE

If the specification and drawings exceed 100 sheets of paper (excluding electronically filed sequence or computer
listings under 37 CFR 1.52(e)), the application size fee due is $270 ($135 for small entity) for each additional 50
sheets or fraction thereof. See 35 U.S.C. 41(a)(1)(G) and 37 CFR 1.16(s).
Total Sheets
__________ - 100 =

Number of each additional 50 or fraction thereof
Extra Sheets
___________ (round up to a whole number) x
___________ / 50 =

Fee ($)
Fee Paid ($)
__________ = ___________

4. OTHER FEE(S)

Non-English Specification, $130 fee (no small entity discount)
Other (e.g., late filing surcharge):__________________________________________________

Fees Paid ($)

____________
____________

SUBMITTED BY

Signature
Name (Print/Type)

Registration No.
(Attorney/Agent)

Telephone
Date

This collection of information is required by 37 CFR 1.136. The information is required to obtain or retain a benefit by the public which is to file (and by the
USPTO to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.14. This collection is estimated to take 30 minutes to complete,
including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. 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 Chief Information Officer, U.S. Patent
and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS
ADDRESS. SEND TO: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.

If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection
with your submission of the attached form related to a patent application or patent. Accordingly,
pursuant to the requirements of the Act, please be advised that: (1) the general authority for the
collection of this information is 35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary;
and (3) the principal purpose for which the information is used by the U.S. Patent and Trademark
Office is to process and/or examine your submission related to a patent application or patent. If you do
not furnish the requested information, the U.S. Patent and Trademark Office may not be able to
process and/or examine your submission, which may result in termination of proceedings or
abandonment of the application or expiration of the patent.
The information provided by you in this form will be subject to the following routine uses:
1. The information on this form will be treated confidentially to the extent allowed under the
Freedom of Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from
this system of records may be disclosed to the Department of Justice to determine whether
disclosure of these records is required by the Freedom of Information Act.
2. A record from this system of records may be disclosed, as a routine use, in the course of
presenting evidence to a court, magistrate, or administrative tribunal, including disclosures to
opposing counsel in the course of settlement negotiations.
3. A record in this system of records may be disclosed, as a routine use, to a Member of
Congress submitting a request involving an individual, to whom the record pertains, when the
individual has requested assistance from the Member with respect to the subject matter of the
record.
4. A record in this system of records may be disclosed, as a routine use, to a contractor of the
Agency having need for the information in order to perform a contract. Recipients of
information shall be required to comply with the requirements of the Privacy Act of 1974, as
amended, pursuant to 5 U.S.C. 552a(m).
5. A record related to an International Application filed under the Patent Cooperation Treaty in
this system of records may be disclosed, as a routine use, to the International Bureau of the
World Intellectual Property Organization, pursuant to the Patent Cooperation Treaty.
6. A record in this system of records may be disclosed, as a routine use, to another federal
agency for purposes of National Security review (35 U.S.C. 181) and for review pursuant to
the Atomic Energy Act (42 U.S.C. 218(c)).
7. A record from this system of records may be disclosed, as a routine use, to the Administrator,
General Services, or his/her designee, during an inspection of records conducted by GSA as
part of that agency’s responsibility to recommend improvements in records management
practices and programs, under authority of 44 U.S.C. 2904 and 2906. Such disclosure shall
be made in accordance with the GSA regulations governing inspection of records for this
purpose, and any other relevant (i.e., GSA or Commerce) directive. Such disclosure shall not
be used to make determinations about individuals.
8. A record from this system of records may be disclosed, as a routine use, to the public after
either publication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent
pursuant to 35 U.S.C. 151. Further, a record may be disclosed, subject to the limitations of 37
CFR 1.14, as a routine use, to the public if the record was filed in an application which
became abandoned or in which the proceedings were terminated and which application is
referenced by either a published application, an application open to public inspection or an
issued patent.
9. A record from this system of records may be disclosed, as a routine use, to a Federal, State,
or local law enforcement agency, if the USPTO becomes aware of a violation or potential
violation of law or regulation.