PTO/SB/67 Requests to Access, Inspect, and Copy

PTO/SB/67 (11-15)
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.

POWER TO INSPECT/COPY - FOR APPLICATIONS FILED BEFORE SEPTEMBER 16, 2012
First Named
Inventor
Application
Number
Title

Docket
Number
Filed

Art Unit

Examiner

Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450

Paper No. ________

Please permit the following person(s) to inspect and make copies of the above-identified application:

Customer Name(s):

__________________________________________

Badge Number(s):

__________________________________________

Company Name (if any): _____________________________________________________________________

Telephone Number:
Fax Number:

__________________________________________

___________________________________________

I am (pursuant to pre - AIA 37 CFR 1.14(c)):
an applicant (inventor).

a registered attorney or agent of record. Registration No. ___________________.
an authorized official of an assignee of record. The assignment was made of record pursuant to 37 CFR 3.71 in the
United States Patent and Trademark Office at Reel __________________, Frame ________________,
or for which a copy thereof is attached.
a registered attorney or agent named in the papers accompanying the application papers filed under 37 CFR 1.53 or the
national stage documents filed under 37 CFR 1.495. An executed 37 CFR 1.63 or 1.497 oath or declaration has not been

filed. Registration No. ________________.
_______________________________________________
Signature
_______________________________________________
Typed or Printed Name
_______________________________________________
Title (Officer of company or corporate assignee)

Date
FOR USPTO USE ONLY
If a CD is ordered:
Date CD ordered: ____________________
Date CD received: ____________________
Date CD given to customer: ______________
Date CD returned by customer: _____________

_______________________________________________
Name of Assignee, if any (e.g., company name)
_______________________________________________
Telephone Number

CD purchased?

YES

NO

Power to Inspect Approved by:
_______________________________________
Unit:__________________________________

This collection of information is required by 37 CFR 1.14. 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 and 1.14. This collection is estimated to take 15
minutes 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 law; to a
Federal,
state, local, or international agency, in response to its request; to an agency, organization, or
individual for the purpose of performing audit or oversight operations as authorized by law; to non-federal
personnel under contract to the agency; to a court for adjudication and litigation; to the Department of
Justice for Freedom of Information Act (FOIA) assistance; to members of congress working on behalf of
an individual;
to the Office of Personnel Management (OPM) for personnel research purposes; to

National Archives and Records Administration for inspection of records; and to 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