Pto Sb 466

sb0466.docx

Patents for Humanity Program

PTO SB 466

OMB: 0651-0066

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Document Description: Transfer Cert Humanitarian Program

PTO/SB/466 (09-22)

Approved for use through 04/30/2025. OMB 0651-0066

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.

TRANSFER OF ACCELERATION CERTIFICATE UNDER THE PATENTS FOR HUMANITY PROGRAM Page 1 of 1

Certificate Number: ___________________________________________________________________

THE UNDERSIGNED HEREBY REQUESTS CONFIRMATION OF THE TRANSFER OF THE ABOVE-IDENTIFIED ACCELERATION CERTIFICATE AND STATES THE FOLLOWING:

1. The undersigned hereby authorizes the transfer of the above-identified acceleration certificate.

2. The above-identified certificate has not been redeemed.

3. It is understood that the decision whether to confirm the transfer of the above-identified certificate rests solely within the Director’s discretion and cannot be challenged before the USPTO.

4. There is no fee for this request.

5. Transferring party contact information:

Certificate owner: ____________________________________________________________________

Individual contact (if certificate owner is a juristic entity): ____________________________________

Address: ____________________________________________________________________________

City: _____________________________

State: ______________

Zip: _______________________

Country: ____________

Phone: ________________

Email: _______________________________

6. Receiving party contact information:

Receiving party: ______________________________________________________________________

Individual contact (if receiving party is a juristic entity): ______________________________________

Address: ____________________________________________________________________________

City: _____________________________ State: ______________ Zip: _______________________

Country: ____________ Phone: ________________ Email: _______________________________

7. If sold for compensation, sale price (optional): ___________________________________________

The individual whose signature and title is supplied below is authorized to act on behalf of the certificate owner.

Signature

Date

Printed Name

Title

Phone

Email

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a currently valid OMB Control Number. The OMB Control Number for this information collection is 0651-0066. Public burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected]. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS.

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. The United States Patent and Trademark Office (USPTO) collects the information in this record under authority of 35 U.S.C. 2. The USPTO’s system of records is used to manage all applicant and owner information including name, citizenship, residence, post office address, and other information with respect to inventors and their legal representatives pertaining to the applicant's/owner’s activities in connection with the invention for which a patent is sought or has been granted. The applicable Privacy Act System of Records Notice for the information collected in this form is COMMERCE/PAT-TM-7 Patent Application Files, available in the Federal Register at 78 FR 19243 (March 29, 2013). https://www.govinfo.gov/content/pkg/FR-2013-03-29/pdf/2013-07341.pdf


Routine uses of the information in this record may include disclosure to: 1) law enforcement, in the event that the system of records indicates a violation or potential violation of law; to a Federal, state, local, or international agency, in response to its request; 2) a contractor of the USPTO having need for the information in order to perform a contract; 3) the Department of Justice for determination of whether the Freedom of Information Act (FOIA) requires disclosure of the record; 4) a Member of Congress submitting a request involving an individual to whom the record pertains, when the individual has requested the Member’s assistance with respect to the subject matter of the record; 5) a court, magistrate, or administrative tribunal, in the course of presenting evidence, including disclosures to opposing counsel in the course of settlement negotiations; 6) the Administrator, General Services Administration (GSA), or their designee, during an inspection of records conducted by GSA under authority of 44 U.S.C. 2904 and 2906, in accordance with the GSA regulations and any other relevant (i.e., GSA or Commerce) directive, where such disclosure shall not be used to make determinations about individuals; 7) 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)); 8) the Office of Personnel Management (OPM) for personnel research purposes; and 9) the Office of Management and Budget (OMB) for legislative coordination and clearance.


If you do not furnish the information requested on this form, the USPTO may not be able to process and/or examine your submission, which may result in termination of proceedings, abandonment of the application, and/or expiration of the patent.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitlePower of Attorney to Prosecute Applications Before the USPTO
AuthorUSPTO
File Modified0000-00-00
File Created2023-08-24

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