DOE F 482.3 Nonexclusive Patent License Application

DOE F 482.3
(08/2021)
All other versions are obsolete

U.S. DEPARTMENT OF ENERGY
NONEXCLUSIVE PATENT LICENSE
APPLICATION

OMB Control No. 1910-0800
Exp. Date:

It is the policy of the U.S. Department of Energy (DOE) to accord licensed on DOE-owned patents
applications in appropriate circumstances to applicants with satisfactory plans for development and/or
marketing of the invention. 37 CFR Part 404, Licensing of Government Owned Inventions, provides terms,
conditions, and procedures for the accord of patent licenses, both nonexclusive, on DOE-owned patents and
patent applications.
An application for a nonexclusive license should set forth the following, and, in addition, any other
information that applicant deems would be of importance to show that the accord of a non-exclusive license
is in the public interest. The application must be accompanied by a processing fee of $25.00. The check or
money order should be made payable to the U.S. Department of Energy.
Applications should be addressed to:
Assistant General Counsel
for Technology Transfer
and Intellectual Property
1000 Independence Avenue, S.W.
Washington, DC 20585
INFORMATION REQUIRED:
1. Identification of Applicant

(a) Name:

(b) Address:
(c) Citizenship and State of Incorporation:
(d) Name, title, and telephone number of
representative of applicant with whom
(1) Name:
negotiations are to be considered:
(2) Title:

(3) Telephone #:

DOE F 482.3
(08/2021)

Section 508 Compliant

DOE F 482.3
(08/2021)
All other versions are obsolete

2.

OMB Control No. 1910-0800
Exp. Date:

Identification of Invention
a. Patent Number of Patent Application Serial Number:

b. Title

3.

Nature and type of applicant’s business, including identification of products or services which
applicant has successfully commercialized, and including approximate number of applicant’s
employees:

4.

Applicant’s status, if applicable, as a small business, as defined at section 2 of Pub. L. 85-535 (15
USC 632) and implementing regulations of the Small Business Administration:

5.

Identification of source of information concerning the availability for license of the invention:

6.

In support of this application, please submit, as an appendix hereto, a detailed description of
applicant’s plan for development and/or marketing of the invention, which should include:
a. A statement as to applicant’s intention to fulfill the plan, including applicant’s manufacturing,
marketing, financial, and technical capability to fulfill the plan;
b. A statement of the time, nature, and amount of anticipated investment of capital and other
resources which applicant believes will be necessary to bring the invention to practical
application;
c. A statement of the field or fields of use for which applicant intends to practice the invention; and

DOE F 482.3
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Section 508 Compliant

DOE F482.3
(08/2021)
All other versions are obsolete

OMB Control No. 1910-0800
Exp. Date:

d. A statement of the geographic areas in which applicant intends to manufacture, use, or sell any
products embodying the invention or produced through the use of the invention.

Date:

Signature

(Name and title of authorized representative)

Enclosure: Check in the amount of $25.00
Payable to: United States Department of Energy

OMB Disclosure Statement
This form is mandatory. Public reporting burden for this collection of information is estimated to average 7.7 hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division,
IM-23, Paperwork Reduction Project OMB control number 1910-0800, U.S. Department of Energy, 1000 Independence Ave SW,
Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project OMB
control number 1910-0800, Washington, DC 20503.

DOE F 482.3
(08/2021)

Page 3 of 3

Section 508 Compliant