Doc code: PET.OP.AGE
Description: Petition to make special based on age/health
PTO/SB/130 (01-19)
Approved for use through 11/30/2020. 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 contains a valid OMB control number
PETITION TO MAKE SPECIAL BASED ON AGE
FOR ADVANCEMENT OF EXAMINATION UNDER 37 CFR 1.102(c)(1)
Application Information
Application
Number
Confirmation
Number
Filing
Date
Attorney Docket
Number (optional)
Art Unit Exa miner
First Named
Inventor
Title of Invention
Attention: Office of Petitions
An application may be made special for advancement of examination upon filing of a petition showing that the applicant is
65 years of age, or more. No fee is required with such a petition. See 37 CFR 1.102(c)(1) and MPEP 708.02 (II).
APPLICANT HEREBY PETITIONS TO MAKE SPECIAL FOR ADVANCEMENT OF EXAMINATION IN THIS APPLICATION UNDER
37 CFR 1.102(c)(1) and MPEP 708.02 (II) ON THE BASIS OF THE APPLICANT'S AGE.
A grantable petition requires one of the following items:
(1) Statement by one named inventor in the application that he/she is 65 years of age, or more; or
(2) Certification by a registered attorney/agent having evidence such as a birth certificate, passport, driver's license,
etc. showing one named inventor in the application is 65 years of age, or more.
Name of inventor who is 65 years of age, or older
Given Name Middle Name Family Name Suffix
A signature of the applicant or representative is required in accordance with 37 CFR 1.33 and 11.18. Please see 37 CFR 1.4(d)
for the format of the signature.
Select (1) or (2):
(1) I am an inventor in this application and I am 65 years of age, or more.
(2) I am an attorney or agent registered to practice before the Patent and Trademark Office, and I certify that I am in
possession of evidence, and will retain such in the application file record, showing that the inventor listed above is
65 years of age, or more.
Signature
Date
(YYYY-MM-DD)
Name
Registration
Number
This collection of information is required by 37 CFR 1.102(c)(1) . The information is required to obtain or retain a benefit by the public, which is to file (and by the
USPTO to process) a petition to make special based on age for advancement of examination. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.14. This
collection is estimated to take 2 hours to complete, including gathering, preparing, and submitting the completed 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 Trad emark Office, U.S. D epartment of Commerce, P.O. Box 145 0, Alexan dria, VA 2 2313-14 50 . DO NOT SEND
COMPLETED FORMS TO THE CHIEF INFORMATION OFFICER. Submit completed forms electronically over EFS-Web, or mail to: Commissioner for Patents, P.O. Box
1450, Alexandria, VA 22313-14 50.
If you need assistance in completing the form, call 1-800-PTO -9199 and select o ptio n 2 .
Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) re qui res that you be gi ven ce rtain i nformation 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 a dvised 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
furni sh the requested i nformation, the U.S. Pa tent and Trademark Office may not be able to process and/or examine your
s ubmission, 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
di s closed to the De partment of Jus tice to de termine whether disclosure of these re cords i s re quired by the
Fre e dom of I nformation Act.
2. A re cord from this s ystem of records may be disclosed, a s a routine use, in the course of presenting e vidence to
a court, magistrate, or administrative tribunal, including disclosures to opposing counsel in the course of
settlement negotiations.
3. A re cord i n this s ystem of records may be disclosed, as a routine use, to a Member of Congress submitting a
re quest involving an i ndividual, to whom the re cord pertains, when the individual has requested assistance from
the Member with respect to the subject matter of the record.
4. A record i n this system of re cords may be disclosed, as a routine use, to a contractor of the Age ncy having need
for the information in order to perform a contract. Recipients of information shall be required to comply with the
requirements of the Pri vacy Act of 1974, a s 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 Pro p e rty
Organization, pursuant to the Patent Cooperation Treaty.
6. A re cord i n this system of re cords may be disclosed, as a routine use, to another fe deral a gency for purposes of
Na ti onal Security review (35 U.S.C. 181) a nd 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 hi s /her designee, during a n inspection of re cords conducted by GSA a s part of that agency’s re sponsibility to
re commend improvements in records management practices and programs, under authority of 44 U.S.C. 2904
a nd 2906. Such disclosure shall be made in a ccordance 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
ma ke determinations a bout i ndividuals.
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
i n a n application which became a bandoned or i n which the proceedings were te rminated a nd which application
i s referenced by e ither a published a pplication, a n application open to public i nspection 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.