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PART B FEE(S) TRANSMITTAL (USPTO)

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PART B – FEE(S) TRANSMITTAL
Complete and send this form, together with the applicable fee(s), by mail or fax, or via EFS-Web.
By mail, send to: M a il St o p I SSU E FE E
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450
By fax, send to: (571) 273-2885
INSTRUCTIONS: This form should be used for transmitting the ISSUE FEE and PUBLICATION FEE (if required). Blocks 1 through 5 should be completed where appropriate.
All further correspondence including the Patent, advance orders and notification of maintenance fees will be mailed to the current correspondence address as indicated unless
corrected below or directed otherwise in Block 1, by (a) specifying a new correspondence address; and/or (b) indicating a separate “ FEE ADDRESS” for maintenance fee
notifications.
CURRENT CORRESPONDENCE ADDRESS (Note: Use Block 1 for any change of address)
Note: A certificate of mailing can only be used for domestic mailings of the
Fee(s) Transmittal. This certificate cannot be used for any other accompanying
papers. Each additional paper, such as an assignment or formal drawing, must
have its own certificate of mailing or transmission.
Certificate of Mailing or Transmission
I hereby certify that this Fee(s) Transmittal is being deposited with the United
States Postal Service with sufficient postage for first class mail in an envelope
addressed to the Mail Stop ISSUE FEE address above, or being transmitted to the
USPTO via EFS-Web or by facsimile to (571) 273-2885, on the date below.
(Typed or printed name)
(Signature)
(Date)
APPLICATION NO
FILING DATE
FIRST NAMED INVENTOR
ATTORNEY DOCKET NO
TITLE OF INVENTION:
APPLN. TYPE
ENTITY STATUS
ISSUE FEE DUE
PUBLICATION FEE DUE
PREV. PAID ISSUE FEE
TOTAL FEE(S) DUE
DATE DUE
EXAMINER
ART UNIT
CLASS-SUBCLASS
1. Change of correspondence address or indication of “Fee
Address” (37 CFR 1.363)
Change of correspondence address (or Change of
Correspondence Address form PTO/SB/122) attached.
“ Fee Address” indication (or “Fee Address” Indication
form PTO/SB/47; Rev 03-09 or more recent)
attached. Use of a Customer Number is required.
2. For printing on the patent front page, list
(1)
The names of up to 3 registered patent attorneys
or agents OR, alternatively,
(2) The name of a single firm (having as a member
a registered attorney or agent) and the names of
up to 2 registered patent attorneys or agents. If
no name is listed, no name will be printed.
1.
2.
3.
3. ASSIGNEE NAME AND RESIDENCE DATA TO BE PRINTED ON THE PATENT (print or type)
PLEASE NOTE: Unless an assignee is identified below, no assignee data will appear on the patent. If an assignee is identified below, the document must have been
previously recorded, or filed fo r recordation, as set forth in 37 CFR 3.11 and 37 CFR 3.81(a). Completion of this form is NOT a substitute for filing an assignment.
(A) NAME OF ASSIGNEE
(B) RESIDENCE: (CITY and STATE or COUNTRY)
Please check the appropriate assignee category or categories (will not be printed on the patent): Individual Corporation or other private group entity Government
4a. Fees Submitted: Issue Fee Publication Fee (if required) Advance Order - # of Copies __________
4b. Method of Payment (Please first reapply any previously paid fee shown above):
Electronic Payment via EFS-Web Enclosed check Non-electronic payment by credit card (Attach form PTO-2038)
The Director is hereby authorized to charge the required fee(s), any deficiency, or credit any overpayment to Deposit Account No. __________
5. Change of Entity Status (from status indicated above)
Applicant certifying micro entity status. See 37 CFR 1.29. NOTE: Absent a valid Certification of Micro Entity Status (see forms PTO/SB/15A and 15B), issue fee
payment in the micro entity amount will not be accepted at the risk of application abandonment.
Applicant asserting small entity status. See 37 CFR 1.27. NOTE: If the application was previously under micro entity status, checking this box will be taken as
a notification of loss of entitlement to micro entity status.
Applicant changing to regular undiscounted fee status. NOTE: Checking this box will be taken as a notification of loss of entitlement to small or micro entity
status, as applicable.
NOTE: This form must be signed in accordance with 37 CFR 1.31 and 1.33. See 37 CFR 1.4 for signature requirements and certifications.
Authorized Signature Date
Typed or printed name Registration No.
PTOL-85 Part B (08-18) Approved for use through 03/31/2023 OMB 0651-0033 U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
s
OMB Clearance and PRA Burden Statement for PTOL-85 Part B
The Paperwork Reduction Act (PRA) of 1995 requires Federal agencies to obtain Office of Management and Budget approval before requesting
most types of information from the public. When OMB approves an agency request to collect information from the public, OMB (i) provides a
valid OMB Control Number and expiration date for the agency to display on the instrument that will be used to collect the information and (ii)
requires the agency to inform the public about the OMB Control Number’s legal significance in accordance with 5 CFR 1320.5(b).
The information collected by PTOL-85 Part B is required by 37 CFR 1.311. 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, Virginia 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Commissioner for Patents, P.O.
Box 1450, Alexandria, Virginia 22313-1450. 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.
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 may be 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 agency’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 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.
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PART B FEE(S) TRANSMITTAL (USPTO)

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Completed 17 July 2021

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