Fillable Form PTO/SB/15A or B or equivalent must either (USPTO)

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Form PTO/SB/15A or B or equivalent must either (USPTO)

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PTO/SB/17 (10-20)
Approved for use through 12/31/2020. OMB 0651-0032
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
FEE TRANSMITTAL
Complete if known
Application Number
Filing Date
Applicant asserts small entity status. See 37 CFR 1.27.
First Named Inventor
Applicant certifies micro entity status. See 37 CFR 1.29.
Form PTO/SB/15A or B or equivalent must either be enclosed or have
been submitted previously.
Examiner Name
Art Unit
TOTAL AMOUNT OF PAYMENT
($)
Practitioner Docket No.
METHOD OF PAYMENT (check all that apply)
Check Credit Card
Money Order None Other (please identify): ___________________________________________
Deposit Account Deposit Account Number: _______________________ Deposit Account Name: ______________________
For the above-identified deposit account, the Director is hereby authorized to (check all that apply):
Charge fee(s) indicated below Charge fee(s) indicated below, except for the filing fee
Charge any additional fee(s) or underpayment of fee(s) Credit any overpayment of fee(s)
under 37 CFR 1.16 and 1.17
WARNING: Information on this form may become public. Credit card information should not be included on this form. Provide credit card
information and authorization on PTO-2038.
FEE CALCULATION
1. BASIC FILING, SEARCH, AND EXAMINATION FEES (U = undiscounted fee; S = small entity fee; M = micro entity fee)
FILING FEES
SEARCH FEES
EXAMINATION FEES
Application Type
U ($)
S ($)
U ($)
S ($)
M ($)
U ($)
S ($)
M ($)
Fees Paid ($)
Utility
320 160* 80 700 350 175 400 200
Design
220 110 55
160
80
40
320 160
Plant
220 110 55 440 220 110 330 165
Reissue
320 160 80 700 350 175 1,160 580
Provisional
300 150 75
0
0
0
800
640
660
2,320
0
0
0
* The $160 small entity status filing fee for a utility application is further reduced to $80 for a small entity status applicant who files the application via EFS-Web.
2. EXCESS CLAIM FEES
Fee Description
Undiscounted Fee ($)
Micro Entity Fee ($)
Each claim over 20 (including Reissues)
25
Each independent claim over 3 (including Reissues)
120
Multiple dependent claims
100
480
860
Small Entity Fee ($)
50
240
430 215
Total Claims
Extra Claims
Fee ($)
Fee Paid ($)
__________
-20 or HP =
__________ x
__________ =
__________
Multiple Dependent Claims
HP = highest number of total claims paid for, if greater than 20.
Fee ($)
Fee Paid ($)
Indep. Claims
Extra Claims
Fee ($)
Fee Paid ($)
__________
__________
__________
-3 or HP =
__________ x
__________ =
__________
HP = highest number of independent claims paid for, if greater than 3.
3. APPLICATION SIZE FEE
If the specification and drawings exceed 100 sheets of paper (excluding electronically filed sequence or computer listings under 37 CFR 1.52(e)),
the application size fee due is $420 ($210 for small entity) ($105 for micro entity) for each additional 50 sheets or fraction thereof. See 35 U.S.C.
41(a)(1)(G) and 37 CFR 1.16(s).
Total Sheets
Extra Sheets
Number of each additional 50 or fraction thereof
Fee ($)
Fee Paid ($)
__________ - 100 =
__________ / 50 =
__________ (round up to a whole number) x
__________ =
__________
Fees Paid ($)
__________
__________
4. OTHER FEE(S)
Non-English specification, $140 fee ($70 for small entity) ($35 for micro entity)
Non-electronic filing fee under 37 CFR 1.16(t) for a utility application, $400 fee ($200 small or micro entity)
Other (e.g., late filing surcharge): _______________________________________________________________________
__________
SUBMITTED BY
Signature
Registration No.
(Attorney/Agent)
Telephone
Name (Print/Type) Date
This collection of information is required by 37 CFR 1.136. 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 1.14. This collection is estimated to take 30 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 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
I
nformation Act (5 U.S.C. 552) and the Privacy Act (5 U.S.C 552a). Records from this system
of
r
ecords may be disclosed to the Department of Justice to determine whether disclosure of thes
e
r
ecords 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 presenti
ng
evidence to a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in
t
he course of settlement negotiations
.
3. A
record in this system of records may be disclosed, as a routine use, to a Member of Congres
s
s
ubmitting a request involving an individual, to whom the record pertains, when the individual
has
r
equested assistance from the Member with respect to the subject matter of the recor
d.
4. A
record in this system of records may be disclosed, as a routine use, to a contractor of the Agenc
y
having need for the information in order to perform a contract. Recipients of information shall be
r
equired 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 thi
s
s
ystem of records may be disclosed, as a routine use, to the International Bureau of the Worl
d
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 f
or
pur
poses of National Security review (35 U.S.C. 181) and for review pursuant to the Atomic Energy Ac
t
(
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, Gener
al
Services, or his/her designee, during an inspection of records conducted by GSA as part of that
agenc
y’s 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 t
he
G
SA regulations governing inspection of records for this purpose, and any other relevant (i.e., GSA
or
C
ommerce) 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
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 routi
ne
us
e, to the public if the record was filed in an application which became abandoned or in which th
e
pr
oceedings 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 loca
l
l
aw enforcement agency, if the USPTO becomes aware of a violation or potential violation of law
or
r
egulati
on.
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Form PTOSB15A or B or equivalent must either (USPTO)

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Completed 4 February 2021

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