DOE F 2000.1 Record Of Invention

DOE F 2000.4
(08/2021)
All other versions are obsolete

U.S. DEPARTMENT OF ENERGY
PATENTS RECORD OF INVENTION

OMB Control No. 1910-0800
Exp. Date:

This Record of Invention is an important legal document and proper care in its DOE Case No.:
early and complete preparation will save important time and inconvenience in
the future. The Instructions on the back should be read carefully before filling
in the data.
A.Inventor Name(s):

B. Title or Position:

C.Employed by

D.Permanent Address:

E. Title of Invention:

F. Description of Invention:

G.Dates and Places of Inventions:
1.

Conception by Inventor at: ___________________________________________________________________

2.

First Sketch or Drawing in Workbook at page ________________

3.

First Written Description in Workbook at page ________________

4.

Disclosure to Others _____________________________
at_________________________________________ a. ______________________________________ 20 ____
at_________________________________________ b. ______________________________________ 20 ____
at_________________________________________ c. ______________________________________ 20 ____

5.

Completion of Model or Full Size Device at: _____________________________________________________

6.

First Test or Operation of Invention ________________________________ at __________________________

H.Results of Tests and Extent of Use of Invention:

I. Names of all Persons having Knowledge of Facts Stated Under D and E:

J. Pertinent Reports:

K.Other Closely Related Publications, Patents, and Patent Applications:

L. Rights of U.S. Government:

M. Licenses or Assignments:

N.Contracts Involved: Contractor and Address

Contract Nos.

Type of Contract:

□

Unclassified

O.Signature of Witness:

Forwarded by:

DOE F 2000.4
(08/2021)

□

Restricted
Date:

□

Confidential

□

Date:

Secret

Signature of Inventor (s):

Date:

Date:

Section 508 Compliant

DOE F 482.4
(07/2021)
All other versions are obsolete

OMB Control No. 1910-0800
Exp. Date:

INSTRUCTIONS
E.

The title of the invention should briefly indicate the name of the article, device or type of machine, materials,
composition, method, or process.

F.

The description of the invention may be brief, provided reference is made to detailed specifications and
drawings, which should be identified by origin, file numbers, and dates. Copies should be attached to this
Report. At the end of the description there should be included a brief statement of what is claimed as new
and patentable.

G.1. Give the earliest date on which, and the place where, the invention suggested itself, even though it was not
completely in mind. If the invention comprises several different inventive ideas, give the conception dates
of each part of the invention separately, taking care to identify each part clearly in the description of the
invention.
G.4. Disclosure to others should be by written description or by sketches and should be authenticated in writing
by two competent persons as follows: "Disclosed to and understood by me this _________ 20___.
(s) ________________." Authentication of disclosure in workbooks is preferred.
H.

State whether or not the invention was found to be operative, and the degree of success attained at each test
of the model or full-sized device. In stating the extent of use of the invention, separate – use by the
Government “ from – commercial use.”

J.

List prior reports having a bearing on the problem to which the invention refers, giving origin, file numbers,
and dates.

K.

List all patents by number, date of grant, and title; list all applications for patents by filing dates, serial
number, and title.

In forwarding the Record, an opinion should be given as to whether or not an application for a patent should be
filed.
If the information submitted on this Record of Invention warrants a classification, the form should be
appropriately classified.

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 482.4
(07/2021)

Section 508 Compliant