PTO/SB/21 Transmittal Form

Doc Code: TRAN.LET
Document Description: Transmittal Letter

PTO/SB/21 (07-09)
Approved for use through XX/XX/XXXX. OMB
0651-0031
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.

Application Number

TRANSMITTAL
FORM

Filing Date
First Named Inventor
Art Unit
Examiner Name

(to be used for all correspondence after initial filing)

Attorney Docket Number

Total Number of Pages in This Submission

ENCLOSURES

(Check all that apply)
After Allowance Communication to TC

Fee Transmittal Form

Drawing(s)
Appeal Communication to Board
of Appeals and Interferences

Licensing-related Papers

Fee Attached

Petition
Petition to Convert to a
Provisional Application
Power of Attorney, Revocation
Change of Correspondence Address

Amendment/Reply
After Final
Affidavits/declaration(s)
Extension of Time Request

Terminal Disclaimer

Express Abandonment Request

Request for Refund

Information Disclosure Statement

CD, Number of CD(s)

Appeal Communication to TC
(Appeal Notice, Brief, Reply Brief)

Proprietary Information
Status Letter
Other Enclosure(s) (please Identify
below):

Landscape Table on CD
Certified Copy of Priority
Document(s)

Remarks

Reply to Missing Parts/
Incomplete Application
Reply to Missing Parts
under 37 CFR 1.52 or 1.53

SIGNATURE OF APPLICANT, ATTORNEY, OR AGENT
Firm Name
Signature
Printed name
Date

Reg. No.

CERTIFICATE OF TRANSMISSION/MAILING
I hereby certify that this correspondence is being facsimile transmitted to the USPTO or deposited with the United States Postal Service with
sufficient postage as first class mail in an envelope addressed to: Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450 on
the date shown below:
Signature

Typed or printed name

Date

This collection of information is required by 37 CFR 1.5. 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 1.11 and1.14. This collection is estimated to 2 hours 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 Administrative 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. The United States
Patent and Trademark Office (USPTO) collects this information under authority of 5 CFR 339.205.
The information in this system of records is used to manage all records of applicant including name,
citizenship, residence, post office address and other information pertaining to the applicant's activities
in connection with the invention for which a patent is sought. Statements containing various kinds of
information with respect to inventors who are deceased or incapacitated, or who are unavailable or
unwilling to make application for patent. The information obtain is protected from disclosure to third
parties in accordance with the Privacy Act.
However, routine uses of this information may include disclosure to the following: to law enforcement
and investigation in the event that the system of records indicates a violation or potential violation of
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or individual for the purpose of performing audit or oversight operations as authorized by
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purposes; to National Archives and Records Administration for inspection of records; and to
research
the Office of Management and Budget (OMB)for legislative coordination and clearance. Failure to
provide any part of the requested information may result in an inability to process requests for access

and information.
The applicable Privacy Act System of Records Notice for this information is
COMMERCE/PAT-TM-7 Patent Application Files, available at Federal Register /Vol. 78, No. 61 /
Friday, March 29, 2013 /Notices 19243. https://www.govinfo.gov/content/pkg/FR-2013-03-29/
pdf/2013-07341.pdf