Fill - Free fillable APPLICATION AS FILED PART I PATENT APPLICATION FEE (USPTO) PDF form

Doc Code: WFEE

Document Description: Fee Worksheet (PTO-875)

PTO/SB/06 (10-20)

Approved for use through 12/31/2020. 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.

PATENT APPLICATION FEE DETERMINATION RECORD

Application or Docket Number

Substitute for Form PTO-875

APPLICATION AS FILED – PART I

LARGE ENTITY

MICRO ENTITY

SMALL ENTITY

(Column 1) (Column 2)

FOR NUMBER FILED NUMBER EXTRA RATE ($) FEE ($)

BASIC FEE

N/A N/A N/A

(37 CFR 1.16(a), (b), or (c))

SEARCH FEE

N/A N/A N/A

(37 CFR 1.16(k), (i), or (m))

EXAMINATION FEE

N/A N/A N/A

(37 CFR 1.16(o), (p), or (q))

TOTAL CLAIMS

minus 20 = * x =

(37 CFR 1.16(i))

INDEPENDENT CLAIMS

minus 3 = * x =

(37 CFR 1.16(h))

APPLICATION SIZE FEE

(37 CFR 1.16(s))

If the specification and drawings exceed 100 sheets

of paper, the application size fee due is $420 ($210

for small entity or $105 for micro entity) for each

additional 50 sheets or fraction thereof. See 35 U.S.C.

41(a)(1)(G) and 37 CFR 1.16(s).

MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1.16(j)) N/A

* If the difference in column 1 is less than zero, enter “0” in column 2. TOTAL

APPLICATION AS AMENDED – PART II

LARGE ENTITY

MICRO ENTITY

SMALL ENTITY

(Column 1) (Column 2) (Column 3)

CLAIMS HIGHEST

REMAINING NUMBER PRESENT ADDITIONAL

RATE ($)

AFTER PREVIOUSLY EXTRA FEE ($)

A T

AMENDMENT PAID FOR

NEMDNEMA

x =

N/A

TOT!L !DD’L FEE

ADDITIONAL

RATE ($)

FEE ($)

TOTAL

* Minus ** =

(37 CFR 1.16(i))

INDEPENDENT

* Minus *** =

(37 CFR 1.16(h))

APPLICATION SIZE FEE (37 CFR 1.16(s))

FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.16(j))

(Column 1) (Column 2) (Column 3)

CLAIMS HIGHEST

REMAINING NUMBER PRESENT

AFTER PREVIOUSLY EXTRA

B T

AMENDMENT PAID FOR

NEMDNEMA

TOTAL

* Minus ** =

(37 CFR 1.16(i))

INDEPENDENT

* Minus *** =

(37 CFR 1.16(h))

APPLICATION SIZE FEE (37 CFR 1.16(s))

FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.16(j))

* If the entry in column 1 is less than the entry in column 2, write “0” in column 3.

** If the “Highest Number Previously Paid For” IN THIS SP!CE is less than 20, enter “20”.

*** If the “Highest Number Previously Paid For” IN THIS SP!CE is less than 3, enter “3”.

The “Highest Number Previously Paid For” (Total or Independent) is the highest number found in the appropriate box in column 1.

x =

N/A

TOT!L !DD’L FEE

The information is required by 37 CFR 1.16. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 12 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 Information 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. Accordingly, pursuant to the

requirements of the Act, please be advised that: (1) the general authority for the collection of this information is

35 U.S.C. 2(b)(2); (2) furnishing of the information solicited is voluntary; and (3) the principal purpose for which

the information is used by the U.S. Patent and Trademark Office is to process and/or examine your submission

related to a patent application or patent. If you do not furnish the requested information, the U.S. Patent and

Trademark Office may not be able to process and/or examine your submission, which m ay result in termination

of proceedings or abandonment of the application or expiration of the patent.

The information provided by you in this form will be subject to the following routine uses:

1. The information on this form will be treated confidentially to the extent allowed under the Freedom

Inf

ormation Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records

may be disclosed to the Department of Justice to determine whether disclosure of these records i

equired by the Freedom of Information Ac

2. A r

ecord from this system of records may be disclosed, as a routine use, in the course of presenti

idence to a court, magistrate, or administrative tribunal, including disclosures to opposing counsel i

the c

ourse of settlement negotiations

3. A r

ecord in this system of records may be disclosed, as a routine use, to a Member of Congress

submitting a request involving an individual, to whom the record pertains, when the individual

has

equested assistance from the Member with respect to the subject matter of the rec

ord.

4. A r

ecord in this system of records may be disclosed, as a routine use, to a contractor of the Agenc

hav

ing need for the information in order to perform a contract. Recipients of information shall be requir

comply with the requirements of the Privacy Act of 1974 , as amended, pursuant to 5 U.S.C. 552a(m).

5. A record related to an International Application filed under the Patent Cooperation Treaty in this sys

tem

of r

ecords may be disclosed, as a routine use, to the International Bureau of the World Intellectua

roperty Organization, pursuant to the Patent Cooperation Treaty

6. A r

ecord in this system of records may be disclosed, as a routine use, to another federal agency f

purpos

es of National Security review (35 U.S.C. 181) and for review pursuant to the Atomic Energy Act

(

42 U.S.C. 218(c))

7. A r

ecord from this system of records may be disclosed, as a routine use, to the Administrator, G

eneral

ervices, or his/her designee, during an inspection of records conducted by GSA as part of that agency’

esponsibility to recommend improvements in records management practices and programs, under

authority of 44 U.S.C. 2904 and 2906. Such disclosure shall be made in accordance with the GS

egulations governing inspection of records for this purpose, and any other relevant (i.e., GSA

Comm

erce) directive. Such disclosure shall not be used to make determinations about individuals

8. A r

ecord from this system of records may be disclosed, as a routine use, to the public after eithe

publ

ication of the application pursuant to 35 U.S.C. 122(b) or issuance of a patent pursuant to 35 U.S.C.

151. Further, a record may be disclosed, subject to the limitations of 37 CFR 1.14, as a routine use, t

the

public if the record was filed in an application which became abandoned or in which the proceedi

ngs

wer

e terminated and which application is referenced by either a published application, an applicati

open to publ

ic inspection or an iss

ued patent.

9. A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local la

enf

orcement agency, if the USPTO becomes aware of a violation or potential violation of law or

regulati

on.

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APPLICATION AS FILED PART I PATENT APPLICATION FEE (USPTO)

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