USA Staffing - Eligibility Questions

OMB Control Number: 0651-0042
Expiration Date: XX/XX/XXXX
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.

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 valid OMB Control Number. The OMB Control Number for this information
collection is 0651-0042. 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 Office of the Chief Administrative Officer, United States Patent
and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected].

0

>?@?Aÿ3434B3C3ÿE
T336UÿVWVWXVYVÿ

12344567





62ÿ[3\37ÿ

ÿÿ!"

893

5453256

52

56

F2
E 13

K L P M6NÿO39 E

GHÿJH

Q R
]

66662ÿ

FF95362ÿ^__5`ÿ

#$.ÿ#!$%/")"0/1)$2"

FF95362cÿd33eÿUfÿ

%%9%+"("%ÿ.:"

#$"%ÿ&'$(%")ÿ*&!"+)+$!ÿ&%,%"")%,- 1/3445/678733 ;&

66662ÿk643256ÿ 66662ÿb3256ÿ 66662ÿl
256635ÿ

66662ÿmn2ÿ

825a32
ÿ

_5`
ÿ

FF95362ÿb5
2cÿFF95362ÿb5
2ÿVÿ

$90

:"%

< h @"0ÿ g

="!"$0" j i0).

8993F
ÿl
256635

66662ÿl
256635
oÿp573F5ÿk643256ÿqVrÿ52
s
tÿd5
2ÿu3

12ÿ6
`ÿmn2fn

tÿv59ÿu3

12ÿ6
`ÿmn2fn

tÿb3
2ÿu3

12ÿ6
`ÿmn2fn

tÿ1wn

u3ÿ1wn

tÿxÿ

12ÿ6
`ÿmn2fn

tÿxÿ

ÿW

12ÿ6
`ÿmn2fn

tÿ852Uym`6

12ÿ6
`ÿmn2fn

tÿ1232ym52Uy[_56
tÿ[
239ÿ8
tÿ862U
tÿm9F6ÿuf

1232ym52Uy[_56
[
239ÿ8
862U
m9F6ÿuf

S

JÿK9786ÿ

Jÿ88L8

K9786ÿ

14
3

MÿK688$8688ÿCNÿ89D
Mÿ

7ÿ

5

7ÿ

5

01ÿ314ÿ56789ÿ

7ÿ

5
ÿ4686ÿ185ÿÿ

7ÿ

5

Mÿ7

ÿO
7881ÿ875ÿ67ÿCOD

Iÿ#1


ÿ314ÿ7ÿ54

ÿ1
ÿ1
9
ÿ
76ÿ9613ÿ8675ÿ
19ÿÿ753ÿ8
8ÿ1
ÿ8ÿ1881ÿÿ3ÿ51
9
314ÿ7
ÿ6157ÿ8ÿÿ79ÿ61576ÿ519948ÿ7
7ÿ1ÿÿ!75753"ÿ#0
314ÿ7
ÿ7638ÿ1ÿ7ÿ1881ÿ7ÿ8ÿ7ÿ1
ÿ$61%ÿÿ
7ÿ6!6ÿ1ÿÿ1881ÿ
19ÿ%85ÿ314ÿ%
ÿ1
ÿ%866ÿ$ÿ7
7"ÿ#0
314ÿ7
ÿ7638ÿ1ÿ7ÿ1881ÿ7ÿ1ÿ1ÿ7!ÿ
7
ÿ
19181ÿ1876ÿ7ÿÿ1881ÿ
19ÿ%85ÿ314ÿ%
ÿ1
ÿ%866ÿ$ÿ7
7"ÿ#0
314
ÿ67ÿ
1
975ÿ
78ÿ1ÿ
51
ÿ8ÿ7ÿ67ÿ4663ÿ45546ÿ1
ÿÿ&48!76'ÿ(1
ÿ91
ÿ81
9781ÿ
!8%ÿÿ*+,-.+ÿ/6ÿ
'
01ÿ345678ÿ8195ÿ4:6;6<6:6=8>ÿ819ÿ?9@=ÿ4$98ÿ41
8ÿ1549781ÿ45ÿ7ÿ7ÿB4581ÿ8ÿ(1
5ÿCB(Dÿ7
781ÿ185ÿ1
ÿ7ÿ
11ÿB91!76E+7
781ÿ185ÿ1ÿ8564ÿ314
ÿ67ÿ
1
975

78ÿC8ÿÿ185ÿ1ÿ1ÿ7!ÿ8ÿ81
9781ÿ8564ÿ314ÿ94ÿ4$98ÿ7ÿ513ÿ1ÿ314
ÿ91ÿ
5ÿ
1
975ÿ7
7876Dÿ7ÿ7ÿ513ÿ1ÿ314
ÿ67ÿ#185781ÿ1ÿ
16ÿ581ÿ+77
ÿ(1
9
FG'
HÿB781ÿ.41ÿÿIE#1

Mÿ
753ÿ7

ÿO
7881ÿ875ÿ67ÿCOD

Iÿ#1


ÿ314ÿ7ÿ54

ÿ1
ÿ1
9
ÿ(
76ÿ9613ÿ8675ÿ
19ÿ7ÿ1881ÿ8ÿ7ÿ(
76ÿ753ÿ1
ÿ7ÿÿ753ÿ8
8ÿ1
ÿ8ÿ1881ÿÿ3ÿ51
9
314ÿ7
ÿ6157ÿ8ÿÿ79ÿ61576ÿ519948ÿ7
7ÿ1ÿÿ!75753"ÿ#0
314ÿ7
ÿ7638ÿ1ÿ7ÿ1881ÿ7ÿ8ÿ7ÿ1
ÿ$61%ÿÿ
7ÿ6!6ÿ1ÿÿ1881ÿ
19ÿ%85ÿ314ÿ%
ÿ1
ÿ%866ÿ$ÿ7
7"ÿ#0
314ÿ7
ÿ7638ÿ1ÿ7ÿ1881ÿ7ÿ1ÿ1ÿ7!ÿ
7
ÿ
19181ÿ1876ÿ7ÿÿ1881ÿ
19ÿ%85ÿ314ÿ%
ÿ1
ÿ%866ÿ$ÿ7
7"ÿ#0
314
ÿ67ÿ
1
975ÿ
78ÿ1ÿ
51
ÿ8ÿ7ÿ67ÿ4663ÿ45546ÿ1
ÿÿ&48!76'ÿ(1
ÿ91
ÿ81
9781ÿ
!8%ÿÿ*+,-.+ÿ/6ÿ
'
01ÿ345678ÿ8195ÿ4:6;6<6:6=8>ÿ819ÿ?9@=ÿ4$98ÿ41
8ÿ1549781ÿ45ÿ7ÿ7ÿB4581ÿ8ÿ(1
5ÿCB(Dÿ7
781ÿ185ÿ1ÿ8564ÿ314
ÿ67ÿ
1
975ÿ
78ÿC8ÿÿ185ÿ1ÿ1ÿ7!ÿ8
81
9781ÿ8564ÿ314ÿ94ÿ4$98ÿ7ÿ513ÿ1ÿ314
ÿ91ÿ
5ÿ
1
975ÿ7
7876Dÿ7ÿ7ÿ513ÿ1ÿ314
ÿ67ÿ#185781ÿ1ÿ
16ÿ581ÿ+77
ÿ(1
9ÿFG'
HÿB781ÿ.41ÿÿIE#1

Mÿ

5ÿCPQÿ89D
MÿR1%ÿ557$6ÿS
7
+65ÿÿ61%ÿ
7ÿ314ÿ7
ÿ%8668ÿ1ÿ755ÿ1
ÿ8ÿ1881'

R1%ÿ557$6ÿS
7

0ÿ23456748ÿ9
68ÿ
ÿ85ÿ87548ÿ8

<ÿÿÿ6646568 ÿ=

23456748ÿ9
68ÿ
ÿ23456748
8485

ÿ6ÿ3ÿ
8ÿ35ÿÿÿ76646568ÿ!ÿ9
68ÿ6"65#
$ÿ 9%&88%8
'$ÿ ("64
9$ÿ )8*
+$ÿ )68%
($ÿ %
*8ÿ%6,865ÿ45&"
)$ÿ 6%*8-%
$ÿ %46%8ÿ'4./'344856%ÿ'
$ÿ &86%4ÿ685/.%6056%
-$ÿ 558ÿ'ÿ656%
$ÿ %6,865ÿ988ÿ)6
1$ÿ %6,865ÿ988ÿ48"8%5ÿ28
$ÿ %6,865ÿÿ'
2$ÿ 
!$ÿ 3ÿ6558
$ÿ ÿ("7488
$ÿ ÿ-%&"56%ÿ86%
4$ÿ ÿÿ8ÿ7.8
5$ÿ ÿ68ÿ.8
$ÿ 76534ÿÿ)6
$ÿ 5
8
0ÿ23456748ÿ9
68ÿ
ÿ23456748ÿ8485

<ÿ46564ÿ776%5"8%5 ÿ=

:8ÿ!

,8ÿ3ÿ
84ÿÿ746564ÿ776%5"8%5ÿ65
6%ÿ5
8ÿ78,63ÿ8,8
8ÿ786
9ÿ56ÿ'355%ÿ
ÿ:8/!

<ÿ+875"8%5ÿ&ÿ9""88ÿ'383 ÿ=
-&ÿ3ÿ8ÿÿ38%5ÿÿ&"8ÿ)884ÿ6,646%ÿ8"7488;ÿÿ
5ÿ.8%/28ÿÿ+875"8%5ÿ&ÿ9""88ÿ383ÿ8ÿ3ÿ8"748
$ÿ -ÿ"ÿ%5ÿÿ38%5ÿ)884ÿ6,646%ÿ8"7488
'$ÿ 5
8ÿ.8%/28ÿ%5ÿ6%ÿ5
8ÿ+875"8%5ÿ&ÿ9""88
9$ÿ +875"8%5ÿ&ÿ9""88;ÿ'383ÿ&ÿ(%"6ÿ%46ÿ'(#
+$ÿ +875"8%5ÿ&ÿ9""88;ÿ'383ÿ&ÿ-%35ÿ%ÿ8365ÿ'-#
($ÿ +875"8%5ÿ&ÿ9""88;ÿ'383ÿ&ÿ5
8ÿ98%3ÿ9(!#
)$ÿ +875"8%5ÿ&ÿ9""88;ÿ(%"6ÿ+8,847"8%5ÿ"6%6556%ÿ(+#
$ÿ +875"8%5ÿ&ÿ9""88;ÿ(%"6ÿ%ÿ55656ÿ"6%6556%ÿ(#
$ÿ +875"8%5ÿ&ÿ9""88;ÿ-%58%56%4ÿ8ÿ"6%6556%ÿ-#
-$ÿ +875"8%5ÿ&ÿ9""88;ÿ26%65ÿ'36%8ÿ+8,847"8%5ÿ.8%ÿ2'+#
$ÿ +875"8%5ÿ&ÿ9""88;ÿ!56%4ÿ-%565358ÿ&ÿ5%ÿ%ÿ8
%4.ÿ!-#
1$ÿ +875"8%5ÿ&ÿ9""88;ÿ!56%4ÿ8%6ÿ%ÿ5"7
86ÿ"6%6556%ÿ!#

23456748ÿ9
68ÿ
ÿ6%.48ÿ8485

01ÿ 34567894
8ÿÿ
99474ÿ68
6ÿ4499
68
ÿ6
ÿ
7968
ÿ9
8768
ÿ
1ÿ 34567894
8ÿÿ
99474ÿ68
6ÿ4
6ÿ
7968
ÿ474ÿ
1ÿ 34567894
8ÿÿ
99474ÿ 4ÿÿ84ÿ474867!ÿ
1ÿ 34567894
8ÿÿ
99474ÿ"11ÿ#684
8ÿ6
ÿ764967$ÿ 4ÿ"#
#1ÿ 34567894
8ÿÿ
99474ÿ 4ÿÿ84ÿ
5487ÿ%4
476
&1ÿ 847
'ÿ854ÿ
4ÿ(ÿ
)4ÿ448

Eÿ+847+ÿ86
ÿ34567894
8ÿÿ
99474 ÿF

78ÿ
*47ÿ408,0

ÿ!ÿ6
*474ÿ+847+ÿ8ÿ84ÿ6,4ÿ-48
ÿ5464ÿ4
847ÿ84ÿ6)4
!ÿ6
ÿ7)6
.68
1
/ÿ408,0ÿ(ÿ56
947ÿ668

Eÿ2#ÿ3ÿ9!8 ÿF

:4ÿ

164ÿ!ÿ64584ÿ6ÿ2
867!ÿ456768
ÿ
4
84ÿ#6!94
8ÿ2#3+,!8+ÿ79ÿ6ÿ44476ÿ6)4
!ÿ*8
ÿ84ÿ568ÿ5ÿ!4676
7ÿ86ÿ988
ÿ(ÿ:43

Eÿ4484ÿ474 ÿF

854ÿ
4ÿ(ÿ
)4ÿ448

ÿ!ÿ674ÿ6ÿ964ÿ68ÿ468ÿ;<ÿ!467ÿÿ6)4ÿ,7
ÿ6847ÿ3449,47ÿ=;ÿ;>5>ÿ64ÿ!ÿ74)8474ÿ*8ÿ84ÿ4484ÿ474ÿ!8496
1ÿ :4
91ÿ 

1ÿ ÿ,8ÿÿ64ÿ6
ÿ65574ÿ404958

31ÿ 8ÿ6556,4
'ÿ854ÿ
4ÿ(ÿ
)4ÿ448

Eÿ848744ÿ*344ÿ

8! ÿF

:4ÿ

74ÿ!ÿ6ÿ748744ÿ744
)ÿ6ÿ44476ÿ6

8!6
?@ABCÿÿ!ÿ674ÿ6
ÿ6

86
8ÿ!7ÿ667!ÿ7ÿ6

8!ÿ96!ÿ,4ÿ744ÿ5
ÿ495!94
81
7ÿ86ÿ988
ÿ(ÿ:43

Eÿ
84486ÿ#75478! ÿF
3ÿ!ÿ64ÿ6
!ÿ468
3405474
4ÿ
ÿ
84486ÿ575478!6
7ÿ86ÿ988
ÿ(ÿ:43

:4ÿ

=ÿ661129
ÿ51ÿ85121ÿ
7
29
ÿ7921 ÿ>

"2ÿ$5

012ÿ456ÿ7ÿ861129
ÿ51ÿ5121ÿ
7
29
ÿ7921ÿ7
ÿ
2ÿÿ
7
29
ÿ79ÿ17271ÿ82ÿ

ÿ75ÿ6

59ÿ!ÿ"2#$5

=ÿ,-5429
ÿ77
2 ÿ>

51
ÿ09&21ÿ2
/5

%ÿ456ÿ79&212ÿ'"2'(ÿ
5ÿ)62
599712ÿ*+(ÿ,-272ÿ-
ÿ4561ÿ7
2ÿ5ÿ2,-5429
ÿ7
ÿ
2ÿ
ÿ%ÿ456ÿ79&212ÿ'$5'ÿ
5ÿ)62
599712ÿ*+(ÿ
4,2ÿ$#0
.ÿ2
/5ÿ!ÿ0-,796218ÿ07-7
59

=ÿ
7
29
ÿ71ÿ7 ÿ>

"2ÿ$5

1702ÿ456ÿ,7 2ÿ
2ÿ
7
29
ÿ71ÿ7
ÿ75ÿ6

59ÿ!ÿ"2#$5

=ÿ,212982ÿ9ÿ%9
2--28
67-ÿ,15,21
4 ÿ>

<6-
,-2ÿ6582ÿ!ÿ<6-
,-2
2-28

%ÿ456ÿ79&212ÿ'"2'ÿ
5ÿ)62
599712ÿ*2(ÿ,-272ÿ987
2ÿ&212ÿ456ÿ5/
792ÿ4561ÿ2687
59ÿ9ÿ9
2--28
67-ÿ,15,21
4ÿ79#51ÿ2,212982ÿ9ÿ,-79993ÿ79ÿ85968
93ÿ42-ÿ5ÿ2718ÿ51ÿ,7
29
ÿ7,,-87
59
51ÿ9ÿ1202&93ÿ51ÿ797-4593ÿ,7
29
ÿ7,,-87
59ÿ
-272ÿ2-28
ÿ7--ÿ
7
ÿ7,,-4
0ÿ 
ÿ2
219,
ÿ 
219,
6ÿ %9
219,
7ÿ
7
29
ÿ271821
ÿ
7
29
ÿ-7&ÿ8-21
8ÿ 97ÿ&
ÿ,287-
4ÿ9ÿ,7
29
ÿ-7&
:ÿ 65612&51
1ÿ 
21
%ÿ %ÿ702ÿ95ÿ2,212982ÿ51ÿ2687
59ÿ9ÿ9
2--28
67-ÿ,15,21
4
;ÿ<6-
,-2ÿ6582ÿ!ÿ<6-
,-2ÿ2-28

=ÿ77
2ÿ,7 2ÿ
7
29
ÿ71ÿ7 ÿ>
%ÿ456ÿ79&212ÿ'"2'ÿ,-272ÿ,1502ÿ
2ÿ7
2ÿ456ÿ,7 2ÿ
2ÿ
7
29
ÿ71ÿ7ÿ%ÿ456ÿ79&212ÿ'$5'(ÿ
4,2ÿ$#0
.ÿ2
/5ÿ!ÿ0-,796218ÿ07-7
59
702ÿ28
59 ÿ 67982-

51
ÿ09&21ÿ2
/5

01233456789

ÿ01233456789ÿ


ÿ0123345678ÿ