PTO/SB/133 (05-18)
APPLICANT HEREBY STATES THE FOLLOWING (please review 37 CFR 1.704(d) before filing this
form):
Each item of information contained in the information disclosure statement was first cited in any
communication from a patent office in a counterpart foreign or international application or from the Office,
and this communication was not received by any individual designated in 37 CFR 1.56(c) more than thirty days
prior to the filing of the information disclosure statement.
AND/OR
Each item of information contained in the information disclosure statement is a communication that was
issued by a patent office in a counterpart foreign or international application or by the Office, and this
communicat
ion was not received by any individual designated in 37 CFR 1.56(c) more than thirty days prior to
the filing of the information disclosure statement.
INSTRUCTIONS:
This form will not satisfy the requirement of 37 CFR 1.97(e). The present statement is filed under 37 CFR
1.704(d) and will not substitute for compliance with any
of the requirements of 37 CFR 1.97 and 1.98. For
an information disclosure statement to comply with 37 CFR 1.97(c) or (d), the information disclosure
state
ment must be accompanied by a statement under 37 CFR 1.97(e) notwithstanding any statement filed
under 37 CFR 1.704(d).
The present form (PTO/SB/133
) should be filed concurrently with the information disclosure statement to
derive benefit under 37 CFR 1.704(d).
Signature
Date
Typed or
Printed Name
Practitioner
Registration Number
Note: Signatures of all the inventors or assignees of record of the entire interest or their representative(s) are required in accord ance
with 37 CFR 1.33 and
11.18. Please see 37 CFR 1.4(d) for the form of the signature. If necessary, submit multiple forms for more
than one signature, see below*.
*Total of forms are submitted.
If you need assistance in completing the form, call 1-80 0-PTO-91 99 an d select o ptio n 2.
PATENT TERM ADJUSTMENT
STATEMENT UNDER 37 CFR 1.704(d)
Filing Date
First Named Inventor
Art Unit
Examiner Name
Practitioner Docket No.
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 may 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 of
Information Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system of records
m a y b e disclosed to the Department of Justice to determine whether disclosure of these records is
required by the Freedom of Information Act.
2. A record from this system of records may be disclosed, as a routine use, in the course of presenting
evidence to a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in
the course of settlement negotiations.
3. A record 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
requested assistance from the Member with respect to the subject matter of the record.
4. A record in this system of records may be disclosed, as a routine use, to a contractor of the Agency
having need for the information in order to perform a contract. Recipients of information shall be required
to 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 system
of records may be disclosed, as a routine use, to the International Bureau of the World Intellectual
Property Organization, pursuant to the Patent Cooperation Treaty.
6. A record in this system of records may be disclosed, as a routine use, to another federal agency for
purposes 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 record from this system of records may be disclosed, as a routine use, to the Administrator, General
Services, or his/her designee, during an inspection of records conducted by GSA as part of that agencys
responsibility 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 GSA
regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA or
Commerce) directive. Such disclosure shall not be used to make determinations about individuals.
8. A record from this system of records may be disclosed, as a routine use, to the public after either
publication 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, to
the public if the record was filed in an application which became abandoned or in which the proceedings
were terminated and which application is referenced by either a published application, an application
open to public inspection or an issued patent.
9. A record from this system of records may be disclosed, as a routine use, to a Federal, State, or local law
enforcement agency, if the USPTO becomes aware of a violation or potential violation of law or
regulation.