Privacy Act Statement

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PTOL-413A (07-16)
Approved for use through XX/XX/XXXX. OMB 0651-0031
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE

Doc Code: M865 or FAI.REQ.INTV

Applicant Initiated Interview Request Form
Application No.:_________________
Examiner:______________________

First Named Applicant:____________________________________
Art Unit:__________ Status of Application:__________________

Tentative Participants:
(1)_____________________________ (2)_______________________________
(3)_____________________________ (4)_______________________________
Proposed Date of Interview:_____________________
Type of Interview Requested:
(1) [ ] Telephonic
(2) [ ] Personal

Proposed Time:__________ ( AM

PM)

(3) [ ] Video Conference

Exhibit To Be Shown or Demonstrated: [ ] YES
[ ] NO
If yes, provide brief description:________________________________________________

Issues To Be Discussed
Issues
(Rej., Obj., etc)

Claims/
Fig. #s

Prior
Art

Discussed

Agreed

Not Agreed

(1)__________

________

______________

[ ]

[ ]

[ ]

(2)__________

________

______________

[ ]

[ ]

[ ]

(3)__________

________

______________

[ ]

[ ]

[ ]

(4)__________
________
______________
[ ]
[ ]
[ ]
[ ] Continuation Sheet Attached
[ ] Proposed Amendment or Arguments Attached
Brief Description of Arguments to be Presented: ___________________________________________

______________________________________________________________________________
An interview was conducted on the above-identified application on ____________________________
NOTE: This form should be completed and filed by applicant in advance of the interview (see MPEP § 713.01). If
this form is signed by a registered practitioner not of record, the Office will accept this as an indication that he or
she is authorized to conduct an interview on behalf of the principal (37 CFR 1.32(a)(3)) pursuant to 37 CFR 1.34.
This is not a power of attorney to any above named practitioner. See the Instruction Sheet for this form, which is
incorporated by reference. By signing this form, applicant or practitioner is certifying that he or she has read the
Instruction Sheet. After the interview is conducted, applicant is advised to file a statement of the substance of this
interview (37 CFR 1.133(b)) as soon as possible. This application will not be delayed from issue because of
applicant’s failure to submit a written record of this interview.

Applicant/Applicant’s Representative Signature
Typed/Printed Name of Applicant or Representative

Examiner/SPE Signature
Applicant's/Applicant's Representative's Telephone Number

Registration Number, if applicable
This collection of information is required by 37 CFR 1.133. 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 24 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.

If you need assistance in completing the form, call 1-800-PTO-9199 and select option 2.

PTOL-413A (08-10)
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.

Doc Code: M865 or FAI.REQ.INTV

Instruction Sheet for:
APPLICANT INITIATED INTERVIEW REQUEST FORM
(Not to be Submitted to the USPTO)

1. If this form is signed by a registered practitioner not of record, the authority to
submit the Applicant Initiated Interview Request Form is pursuant to limited
authority to act in a representative capacity under 37 CFR 1.34 and further
proof of authority to act in a representative capacity may be
required. See 37 CFR 1.34.
The Office will accept the signed form as an indication that the registered
practitioner not of record is authorized to conduct an interview on behalf of the
principal in pursuant to 37 CFR 1.34.
For more information, see the “Conducting an Interview with a Registered
Practitioner Acting in a Representative Capacity” notice which is available on
the USPTO Web site at: http://www.uspto.gov/patents/law/notices/2010.jsp.
2. This is not a power of attorney to any named practitioner. Accordingly, any
registered practitioner not of record named on the form does not have
authority to sign a request to change the correspondence address, a request
for express abandonment, a disclaimer, a power of attorney, or other
document requiring the signature of the applicant, assignee of the entire
interest or an attorney of record. If appropriate, a separate power of attorney
to the named practitioner should be executed and filed in the US Patent and
Trademark Office.
3. Any interview concerning an unpublished application under 35 U.S.C. § 122(b)
with a registered practitioner not of record who obtains authorization through
use of the PTOL-413A will be conducted based on the information and files
supplied by the practitioner in view of the confidentiality requirements of
35 U.S.C. § 122(a).

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