Fillable Formcawi Form CA

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Formcawi Form CA

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This form may only be used to correct or amplify information in:
Renewal registrations. These records cover the renewal copyright in
works that secured copyright protection before January 1, 1978.
GATT registrations. These records cover foreign works that were re-
stored to copyright protection in the United States by the Uruguay
Round Agreements Act.
Group registration for non-photographic databases. These records
cover a group of updates or revisions to a database that does not consist
predominantly of photographs.
To correct or amplify the information in any other type of registration
you must use the online application. If you attempt to use this form
to correct or modify a registration that is not listed above, you will be
required to resubmit your claim through the electronic registration
system. In such cases, the supplementary registration will be effective
as of the date that the online application and filing fee were received.
For information about the online application see www.copyright.gov/
registration
Use Form CA When:
• The Copyright Office has issued a renewal registration, a GATT reg-
istration, or a group registration for a non-photographic database;
and
• The information given in that registration is incorrect or incomplete;
and
• You want to correct and/or add information to the record.
Purpose of Supplementary Registration: As a general rule, the Copy-
right Office will issue only one basic copyright registration for the same
work. But where information in the basic registration turns out to be
incorrect or incomplete, section 408(d) of the copyright law authorizes
the Copyright Office to issue a “supplementary registration, to cor-
rect an error in a copyright registration or to amplify the information
given in a registration.”
Who May File Form CA: Once the Copyright Office has issued a GATT
registration or a group registration for a non-photographic database,
an application for a supplementary registration may be filed by any
author, any other copyright claimant, any owner of any exclusive right
in the work who wishes to correct or amplify the information given in
the basic registration, or a duly authorized agent of any such author,
claimant, or owner.
To correct or amplify the information in a renewal registration, the
application for supplementary registration may be filed by any author,
or any vested owner or current owner identified in the renewal regis-
tration, or their successor or duly authorized agent.
Please Note: Do not use Form CA to correct errors in the statements
that appear on the copies or phonorecords of the work in question
or to reflect changes in the content of the work. If the work has been
changed substantially, filing Form CA is not appropriate. To register
additions or revisions to the work you may submit a new application
for the revised version of the work.
Do not use this application as a substitute for a renewal registration.
For other restrictions on supplementary registration for works that
secured copyright protection before 1978, see 37 C.F.R. §202.6 and the
Compendium of U.S. Copyright Office Practices, Third Edition, Chapter
2100, Sections 2131 and 2138.3.
Do not use Form CA as a substitute for recording a transfer of copy-
right or other document pertaining to rights under a copyright. Re-
cording a document under section 205 of the Copyright Act gives all
persons constructive notice of the facts stated in the document and
may have other important consequences in cases involving conflicting
transfers. A supplementary registration does not provide these ben-
efits. For information on recording a document, see the Compendium,
Chapter 2300.
Do not use Form CA to request removal of certain personally identifi-
able information from the database posted on the Office’s website, such
as driver’s license numbers, social security numbers, banking informa-
tion, and credit card information. For more information on the appro-
priate method for submitting this type of request, see the Compendium,
Chapter 1800, Section 1805.
How to Apply for Supplementary Registration
First: Read the information on this page to make sure that a supple-
mentary registration is the service you need, and that Form CA is the
application that should be used to correct or modify the information
in your basic registration.
Second: Make sure you have a copy of the certificate for the basic
registration that you want to correct or amplify. You will need to refer
to that certificate when you complete Form CA.
Third: Read the line-by-line instructions on the following pages that
explain how to complete Form CA. You may complete this form online,
save the completed form on your computer, and then print a copy with
your printer. Alternatively, you may complete the form by printing a
copy and writing the appropriate information in black ink.
Fourth: Detach this sheet and send your completed Form CA to the
following address:
Library of Congress
U.S. Copyright Office
101 Independence Avenue SE
Washington, DC 20559-6000
Do not send copies, phonorecords, or supporting documents with
your application. They cannot be made part of the registration record.
The Office will notify you if a copy, phonorecord, or other material is
needed to complete the examination.
Where possible, the Office will use its digital copy of the original cer-
tificate to conduct its examination. If you are correcting or amplifying
a registration that is not available in digital form, the Office will ask
you to provide a copy of the original certificate of registration. If you
are unable to do so, the Office will charge an additional fee to make a
copy of the original registration.
BASIC INFORMATION
4
Form CA
Read these instructions before completing this form.
Make sure all applicable spaces have been filled in before you return this form.
Fee: Your application must be accompanied by the nonrefundable filing
fee. This fee may be paid with a check or money order payable to the
U.S. Copyright Office. Alternatively, you may use a deposit account by
providing the account name and number on the form.
* Note: Copyright Office fees are subject to change. For current
fees, check the Copyright Office website at www.copyright.gov,
write the Copyright Office, or call (202) 707-3000 or 1-877-
476-0778 (toll free).
What Happens When the Copyright Office Issues a Supplementary
Registration? When the Copyright Office issues a supplementary reg-
istration, it will assign a separate registration number and effective
date of registration to the supplementary registration. In addition,
the Office will add that information to the public record for the basic
registration and the supplementary registration. These cross-references
are intended to notify any person who searches the Office’s records that
the Office has issued a supplementary registration that may contain
additional information pertaining to the basic registration, and that
the records for both registrations should be consulted.
The Copyright Office will not cancel or replace the basic registration
or the registration number for that registration. The basic registration
and the supplementary registration coexist in the public record, and
the supplementary registration augments – but does not supersede –
the information set forth in the basic registration.
For Further Information
• On the Web: Circulars, announcements, regulations, and all copy-
right application forms are available at www.copyright.gov.
• Telephone: For general information about copyright, call the Public
Information Office at (202) 707-3000 or 1-877-476-0778 (toll free).
Staff members are on duty from 8:30 a.m through 5:00 p.m., Eastern
time, Monday through Friday, except federal holidays. Recorded
information is available twenty-four hours a day.
• Regular Mail: Write to:
Library of Congress
Copyright Office
Publications Section
101 Independence Avenue SE
Washington, DC 20559-6304
LINE-BY-LINE INSTRUCTIONS
Please type or print neatly using dark ink. The information in this form is used to produce the certificate.
SPACE A: Identification of Basic Registration
General Instructions: The information provided in
space A will be used to identify the basic registration that
will be corrected or amplified by the supplementary registration.
The information provided in this space should be identical to the
corresponding information that appears in the basic registration,
even if you intend to change that information with Form CA.
Do not provide any new information in this section of the form.
Title of Work: Give the title exactly as it appears in the basic
registration.
Registration Number: Give the registration number (the se-
ries of numbers preceded by two or more letters) exactly as it
appears in the upper right-hand corner of the certificate of
registration. You should provide only one registration number
because Form CA may only be used to correct or amplify one
basic registration.
Registration Date: Give the year of registration for the basic
registration exactly as it appears in the upper right-hand corner
of the certificate of registration.
Name(s) of Author(s) and Copyright Claimant(s): Give the
name(s) of all the author(s) and claimant(s) exactly as they ap-
pear in the basic registration. For renewal registrations, give the
names of the author(s) and vested owner(s). For GATT regis-
trations, give the name(s) of the author(s) and owner(s) of U.S.
rights. For group registrations for non-photographic databases,
give the name(s) of the author(s) and claimant(s).
SPACE B: Correction
General Instructions: Complete space B only if infor-
mation in the basic registration was incorrect at the time
that basic registration was made. If you intend to add, update, or
clarify information (instead of correcting an error), leave space
B blank and complete space C.
Location and Nature of Incorrect Information: Give the line
number and the heading for the space in the basic registration
where the error occurs. Example: Line number 2: Citizenship
of author.
Incorrect Information as It Appears in Basic Registration:
Transcribe the incorrect information exactly as it appears in
the basic registration, even if you already gave this information
in space A.
Corrected Information: Give the correct information that
should have appeared in the basic registration.
Explanation of Correction: You may add a brief explanation
for the correction in this space.
A
SPACE C: Amplification
General Instructions: Complete this space if you want
to provide any of the following information: (1) add-
ing information that should have been included in the basic
registration that was omitted when the registration was made;
(2) clarifying the information that appears in the basic registra-
tion; (3) identifying changes in facts that have occurred since the
registration was made, such as a change in the title of the work
or the address for the copyright claimant. Note: Do not include
any changes in the ownership of the work. As mentioned above,
a supplementary registration cannot be used for this purpose.
Location and Nature of Information to Be Amplified: Give the
line number and the heading for the space in the basic registra-
tion that will be amplified by the information provided in the
supplementary registration.
Amplified Information: Provide a clear and succinct statement
containing the additional, updated, or explanatory information
that should be reflected in the supplementary registration. You
may add a brief explanation for the amplification.
SPACES D,E,F,G,H:
Continuation, Fee, Certi-
fication, Return Address
Continuation (Spaces D & E): Use these spaces if you need
more room to complete spaces B or C.
Correspondence (Space F): In the space marked “Correspon-
dence” provide the name, address, telephone and fax numbers,
and email address for the person who should be contacted if the
Copyright Office has questions concerning your application.
Please note that if you provide an email address, the Office will
use that address as the primary means if there are questions
about your application, even if you also provide a telephone
number, fax number, or other contact information.
Deposit Account (Space F): If you maintain a deposit account
with the Copyright Office, provide the number for your account
in this space. If you do not have a deposit account, you must
submit the form with a check or money order for the nonre-
fundable filing fee.
Certification (Space G): This space must be signed by the au-
thor, copyright claimant/vested owner/owner of the U.S. copy-
right, the owner of exclusive right(s) in the work, or the duly
authorized agent of such author, claimant, or owner.
Address for Return of Certificate (Part H): Provide the mail-
ing address where the certificate of supplementary registration
should be sent.
C
D,E,F,G,H
B
PRIVACY ACT ADVISORY STATEMENT Required by the Privacy Act of 1974 (P.L. 93-579)
The authority for requesting this information is title 17 U.S.C. §408(d) and §410. Furnishing the requested information is voluntary. But if the information is not furnished, it may be necessary to delay or refuse
registration and you may not be entitled to certain relief, remedies, and benets provided in chapters 4 and 5 of title 17 U.S.C.
The principal uses of the requested information are the establishment and maintenance of a public record and the examination of the application for compliance with the registration requirements of the copyright law.
Other routine uses include public inspection and copying, preparation of public indexes, preparation of public catalogs of copyright registrations, and preparation of search reports upon request.
NOTE: No other advisory statement will be given in connection with this application. Please keep this statement and refer to it if we communicate with you regarding this application.
Title of Work as It Appears on the Basic Registration t
Registration Number of the Basic Registration t Year of Basic Registration t
Name(s) of Author(s) t Name(s) of Copyright Claimant(s) t
For Database Registrations: Name(s) of Author(s) and Claimant(s) as they appear in the basic registration. For Renewal Registrations: Name(s) of Author(s) and Vested
Owner(s) as they appear in the basic registration. For GATT Registrations: Name(s) of Author(s) and Owner(s) of U.S. Copyright as they appear in the basic registration.
Line Number and Heading Where the Incorrect Information Appears in the Basic Registration t
Line Number _________________________ Line Heading or Description _____________________________________________________________
Incorrect Information as It Appears in Basic Registration t
Corrected Information t
Explanation of Correction t
Line Number and Heading in the Basic Registration Where Amplified Information is Needed t
Line Number _________________________ Line Heading or Description _____________________________________________________________
Amplified Information t
Explanation for the Amplification t
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
MORE ON BACK
DO NOT WRITE HERE
Page 1 of pages
• Complete all applicable spaces (D-H) on the reverse side of this page.
• See detailed instructions. • Sign the form at Space G.
B
A
C
Form CA
3
For Supplementary Registration
UNITED STATES COPYRIGHT OFFICE
REGISTRATION NUMBER
TX TXU PA PAU VA VAU SR SRU RE
EFFECTIVE DATE OF SUPPLEMENTARY REGISTRATION
Month Day Year
t
Privacy Act Notice: Sections 408-410 of title 17 of the
United States
Code
authorize the Copyright Office to collect the personally identifying
information requested on this form in order to process the applica-
tion for copyright registration. By providing this information you are
agreeing to routine uses of the information that include publication
to give legal notice of your copyright claim as required by 17 U.S.C.
§705. The information will appear in the Office’s online catalog. If you
do not provide the information requested, registration may be refused
or delayed, and you may not be entitled to certain relief, remedies, and
benefits under the copyright law.
Copyright Office fees are subject to change. For
current fees, check the Copyright Office website
at
www.copyright.gov,
write the Copy right Office,
or call (202) 707-3000 or 1-877-476-0778.
Use this space if you need more room to complete space B
Use this space if you need more room to complete space C
Correspondence: Give the name and address of the person the Copyright Office should contact if it has questions about this application.
Phone (______)______________________________ Fax (______)______________________________ Email ______________________________________
Deposit Account: If you would like to charge the filing fee to your deposit account in the Copyright Office, give the name and number for your account.
Name _______________________________________________________________________________________________________________________________
Account Number ________________________________________________
Certification* I, the undersigned, hereby certify that I am the: (Check only one)
q author q owner of exclusive right(s)
 q other copyright claimant/vested q duly authorized agent of ____________________________________________________________
owner/owner of U.S. Copyright
Name of author or other copyright claimant, or owner of exclusive right(s)
s
of the work identified in this application, that I have reviewed the certificate of registration for this work, and that the statements
made by me in this application are correct to the best of my knowledge.
Typed or printed name t Date t
Signature (X) t
YOU MUST:
• Complete all necessary spaces
• Sign your application in Space G
1. Application form
2. Nonrefundable ling fee in check or
money order payable to U.S. Copyright
Ofce
Library of Congress
U.S. Copyright Ofce
101 Independence Avenue SE
Washington, DC 20559-6000
FORM CA
FORM CA RECEIVED
FUNDS RECEIVED DATE
EXAMINED BY
CORRESPONDENCE q
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
FOR
COPYRIGHT
OFFICE
USE
ONLY
G
D
F
Name t
Number/Street/Apt t
City/State/ZIP t
*17 U.S.C. §506(e): Any person who knowingly makes a false representation of a material fact in the application for copyright registration provided for by section 409, or in any written statement led in connection
with the application, shall be ned not more than $2,500.
Certificate
will be
mailed in
window
envelope
to this
address:
H
SEND ALL ELEMENTS IN THE
SAME PACKAGE:
MAIL TO:
Form CA–Full Rev: 05
⁄
2019 Printed on recycled paper U.S. Government Printing Ofce: 2019-xxx-xxx ⁄ xx,xxx
E
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Formcawi Form CA

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Completed 10 July 2020

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