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. §409 and §410. Furnishing the re-
quested 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 code.
Other routine uses include public inspection and copying, preparation of public indexes, prepara-
tion 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.
Name of Author: The fullest form of the author’s name should be given. Unless the
work was made for hire, the individual who actually created the work is its author.
In the case of a work made for hire, the statute provides that “the employer or other
person for whom the work was prepared is considered the author.
What Is a “Work Made for Hire”? A “work made for hire” is defined as (1) “a work
prepared by an employee within the scope of his or her employment”; or (2) “a work
specially ordered or commissioned for use as a contribution to a collective work, as a
part of a motion picture or other audiovisual work, as a translation, as a supplemen-
tary work, as a compilation, as an instructional text, as a test, as answer material for a
test, or as an atlas, if the parties expressly agree in a written instrument signed by them
that the work shall be considered a work made for hire. If you have checked “Yes” to
indicate that the work was “made for hire, you must give the full legal name of the
employer (or other person for whom the work was prepared). You may also include
the name of the employee along with the name of the employer (for example: “Elster
Music Co., employer for hire of John Ferguson”).
Anonymous” or “Pseudonymous” Work: An author’s contribution to a work is
“anonymous” if that author is not identified on the copies or phonorecords of the work.
An author’s contribution to a work is “pseudonymous” if that author is identified on
the copies or phonorecords under a fictitious name. If the work is “anonymous” you
may (1) leave the line blank; (2) state “anonymous” on the line; or (3) reveal the author’s
identity. If the work is “pseudonymous” you may (1) leave the line blank; (2) give the
pseudonym and identify it as such (example: “Huntley Haverstock, pseudonym); or (3)
reveal the author’s name, making clear which is the real name and which is the pseud-
onym (for example: “Judith Barton, whose pseudonym is Madeline Elster”). However,
the citizenship or domicile of the author must be given in all cases.
Dates of Birth and Death: If the author is dead, the statute requires that the year of
death be included in the application unless the work is anonymous or pseudonymous.
The author’s birth date is optional but is useful as a form of identification. Leave this
space blank if the author’s contribution was a “work made for hire.
Author’s Nationality or Domicile: Give the country of which the author is a citi-
zen, or the country in which the author is domiciled. Nationality or domicile must be
given in all cases.
When to Use This Form: Use Form PA for registration of published or unpublished
works of the performing arts. This class includes works prepared for the purpose of
being “performed” directly before an audience or indirectly “by means of any device
or process. Works of the performing arts include: (1) musical works, including any
accompanying words; (2) dramatic works, including any accompanying music; (3)
pantomimes and choreographic works; and (4) motion pictures and other audiovisual
works.
Unpublished works: This form may be used to register one unpublished work. This
form cannot be used to register a “collection of two or more unpublished works. Any
paper application submitted with more than one unpublished work may be refused.
To register multiple unpublished works, you must use the online application for
A Group of Unpublished Works. For information about the online application, see
Multiple Works (Circular 34).
Deposit to Accompany Application: An application for copyright registration must be
accompanied by a deposit consisting of copies or phonorecords representing the entire
work for which registration is made. The following are the general deposit requirements
as set forth in the statute:
Unpublished Work: Deposit one complete copy (or phonorecord).
Published Work: Deposit two complete copies (or one phonorecord) of the best
edition.
Work First Published Outside the United States: Deposit one complete copy (or
phonorecord) of the first foreign edition.
Contribution to a Collective Work: Deposit one complete copy (or phonorecord)
of the best edition of the collective work.
Motion Pictures: Deposit both of the following: (1) a separate written description
of the contents of the motion picture; and (2) for a published work, one complete
Title of This Work: Every work submitted for copyright registration must
be given a title to identify that particular work. If the copies or phonorecords of the
work bear a title (or an identifying phrase that could serve as a title), transcribe that
wording completely and exactly on the application. Indexing of the registration and
future identification of the work will depend on the information you give here. If the
work you are registering is an entire collective work” (such as a collection of plays or
songs), give the overall title of the collection. If you are registering one or more indi-
vidual contributions to a collective work, give the title of each contribution, followed
by the title of the collection. For an unpublished collection, you may give the titles of
the individual works after the collection title.
Previous or Alternative Titles: Complete this space if there are any additional
titles for the work under which someone searching for the registration might
be likely to look, or under which a document pertaining to the work might be
recorded. If you need a additional space, request a Continuation Sheet (Form CON).
Nature of This Work: Briefly describe the general nature or character of the work
being registered for copyright. Examples: “Music”; “Song Lyrics”; “Words and Music”;
“Drama”; “Musical Play”; “Choreography”; “Pantomime”; “Motion Picture”;Audio-
visual Work.
General Instructions: After reading these instructions, decide who are the
“authors” of this work for copyright purposes. Then, unless the work is a “collective
work, give the requested information about every “author” who contributed any appre-
ciable amount of copyrightable matter to this version of the work. If you need further
space, request additional Continuation Sheets. In the case of a collective work such as
a songbook or a collection of plays, give information about the author of the collec-
tive work as a whole.
copy of the best edition of the motion picture; or, for an unpublished work, one
complete copy of the motion picture or identifying material. Identifying material
may be either an audiorecording of the entire soundtrack or one frame enlargement
or similar visual print from each 10-minute segment.
The Copyright Notice: Before March 1, 1989, the use of copyright notice was man-
datory on all published works, and any work first published before that date should
have carried a notice. For works first published on and after March 1, 1989, use of
the copyright notice is optional. For more information about copyright notice, see
Copyright Notice (Circular 3).
For Further Information: To speak to a Copyright Office staff member, call
(202) 707-3000 or 1-877-476-0778 (toll free). Recorded information is available
24 hours a day. Order forms and other publications from the address in space 9 or call
(202) 707-9100 or 1-877-476-0778 (toll free). Access and download circulars, certain
forms, and other information from the Copyright Office website at www.copyright.gov.
4
Form PA
Detach and read these instructions before completing this form.
Make sure all applicable spaces have been filled in before you return this form.
BASIC INFORMATION
LINE-BY-LINE INSTRUCTIONS
Please type or print using black ink. The form is used to produce the certificate.
SPACE 1: Title
1
SPACE 2: Author(s)
2
(3) File Form SR if you are seeking to register the “sound recording” itself, that is,
the work that results from the fixation of a series of musical, spoken, or other sounds,
but not the underlying musical or dramatic work.
(4) File Form SR if you are the copyright claimant for both the underlying musi-
cal or dramatic work and the sound recording, and you prefer to register both on the
same form.
(5) File both forms PA and SR if the copyright claimant for the underlying work
and sound recording differ, or you prefer to have separate registration for them.
“Copies” and “Phonorecords”: To register for copyright, you are required to deposit
copies” or “phonorecords. These are defined as follows:
Musical compositions may be embodied (fixed) in copies, objects from which a
work can be read or visually perceived, directly or with the aid of a machine or device,
such as manuscripts, books, sheet music, film, and videotape. They may also be fixed
in “phonorecords,” objects embodying fixations of sounds, such as tapes and phono-
graph disks, commonly known as phonograph records. For example, a song (the work
to be registered) can be reproduced in sheet music (“copies”) or phonograph records
(“phonorecords”), or both.
How to Register a Recorded Work: If the musical or dramatic work that you are reg-
istering has been recorded (as a tape, disk, or cassette), you may choose either copyright
application Form PA (Performing Arts) or Form SR (Sound Recordings), depending on
the purpose of the registration.
Use Form PA to register the underlying musical composition or dramatic work.
Form SR has been developed specifically to register a “sound recording” as defined by
the Copyright Act—a work resulting from the “fixation of a series of sounds, separate
and distinct from the underlying musical or dramatic work. Form SR should be used
when the copyright claim is limited to the sound recording itself. (In one instance, Form
SR may also be used to file for a copyright registration for both kinds of works—see
[
4
] below.) Therefore:
(1) File Form PA if you are seeking to register the musical or dramatic work, not
the “sound recording, even though what you deposit for copyright purposes may be
in the form of a phonorecord.
(2) File Form PA if you are seeking to register the audio portion of an audiovisual
work, such as a motion picture soundtrack; these are considered integral parts of the
audiovisual work.
Nature of Authorship: Give a brief general statement of the nature of this par-
ticular author’s contribution to the work. Examples: “Words”; “Coauthor of
Music”; “Words and Music”; Arrangement”; “Coauthor of Book and Lyrics”; “Dra
-
matization”; “Screen Play”; “Compilation and English Translation”; “Editorial
Revisions.
General Instructions: Do not confuse “creation with “publication. Every
application for copyright registration must state “the year in which creation of the
work was completed. Give the date and nation of first publication only if the work
has been published.
Creation: Under the statute, a work is “created” when it is fixed in a copy or pho-
norecord for the first time. Where a work has been prepared over a period of time, the
part of the work existing in fixed form on a particular date constitutes the created work
on that date. The date you give here should be the year in which the author completed
the particular version for which registration is now being sought, even if other versions
exist or if further changes or additions are planned.
Publication: The statute defines “publication as “the distribution of copies or pho-
norecords of a work to the public by sale or other transfer of ownership, or by rental,
lease, or lending”; a work is also “published” if there has been an “offering to distribute
copies or phonorecords to a group of persons for purposes of further distribution,
public performance, or public display. Give the full date (month, day, year) when, and
the country where, publication first occurred. If first publication took place simultane-
ously in the United States and other countries, it is sufficient to state “U.S.A.
Name(s) and Address(es) of Copyright Claimant(s): Give the name(s) and
address(es) of the copyright claimant(s) in this work even if the claimant is the same
as the author. Copyright in a work belongs initially to the author of the work (includ-
ing, in the case of a work made for hire, the employer or other person for whom the
work was prepared). The copyright claimant is either the author of the work or a
person or organization to whom the copyright initially belonging to the author has
been transferred.
Transfer: The statute provides that, if the copyright claimant is not the author,
the application for registration must contain “a brief statement of how the claimant
obtained ownership of the copyright. If any copyright claimant named in space 4 is
not an author named in space 2, give a brief statement explaining how the claimant(s)
obtained ownership of the copyright. Examples: “By written contract”; Transfer of all
rights by author”; Assignment”; “By will.” Do not attach transfer documents or other
attachments or riders.
General Instructions: The questions in space 5 are intended to show whether
an earlier registration has been made for this work and, if so, whether there is any basis
for a new registration. As a general rule, only one basic copyright registration can be
made for the same version of a particular work.
Same Version: If this version is substantially the same as the work covered by a pre-
vious registration, a second registration is not generally possible unless (1) the work has
been registered in unpublished form and a second registration is now being sought to
cover this first published edition; or (2) someone other than the author is identified as
copyright claimant in the earlier registration, and the author is now seeking registration
in his or her own name. If either of these two exceptions applies, check the appropri-
ate box and give the earlier registration number and date. Otherwise, do not submit
Form PA; instead, contact the Copyright Office for information about supplementary
registration or recordation of transfers of copyright ownership.
Changed Version: If the work has been changed and you are now seeking registra-
tion to cover the additions or revisions, check the last box in space 5, give the earlier
registration number and date, and complete both parts of space 6 in accordance with
the instructions below.
Previous Registration Number and Date: If more than one previous registration
has been made for the work, give the number and date of the latest registration.
General Instructions: Complete space 6 if this work is a “changed version,
compilation, or derivative work, and if it incorporates one or more earlier works
that have already been published or registered for copyright or that have fallen into
the public domain. A “compilation is defined as “a work formed by the collection
and assembling of preexisting materials or of data that are selected, coordinated, or
arranged in such a way that the resulting work as a whole constitutes an original work
of authorship. A “derivative work” is “a work based on one or more preexisting works.
Examples of derivative works include musical arrangements, dramatizations, trans-
lations, abridgments, condensations, motion picture versions, or “any other form in
which a work may be recast, transformed, or adapted. Derivative works also include
works “consisting of editorial revisions, annotations, or other modifications” if these
changes, as a whole, represent an original work of authorship.
Preexisting Material (space 6a): Complete this space and space 6b for derivative
works. In this space identify the preexisting work that has been recast, transformed, or
adapted. For example, the preexisting material might be: “French version of Hugo’s Le
Roi s’amuse. Do not complete this space for compilations.
Material Added to This Work (space 6b): Give a brief general statement of the addi-
tional new material covered by the copyright claim for which registration is sought. In
the case of a derivative work, identify this new material. Examples: Arrangement for
piano and orchestra”; “Dramatization for television”; “New film version”; “Revisions
throughout; Act III completely new.” If the work is a compilation, give a brief general
statement describing both the material that has been compiled and the compilation
itself. Example: “Compilation of 19th Century Military Songs.
Deposit Account: If you maintain a deposit account in the Copyright Office, identify
it in space 7a. Otherwise, leave the space blank and send the fee with your application
and deposit.
Correspondence (space 7b): Give the name, address, area code, telephone number,
fax number, and email address of the person to be consulted if correspondence about
this application becomes necessary.
Certification (space 8): The application cannot be accepted unless it bears the date
and the signature of the author or other copyright claimant, the owner of exclusive
right(s), or the duly authorized agent of the author, claimant, or owner of exclusive
right(s).
Address for Return of Certificate (space 9): The address box must be completed
legibly since the certificate will be returned in a window envelope.
SPACE 3: Creation and Publication
3
SPACE 4: Claimant(s)
4
SPACE 5: Previous Registration
5
SPACE 6: Derivative Work or Compilation
6
SPACE 7,8,9: Fee, Correspondence,
Certication, Return Address
7,8,9
MORE INFORMATION
3
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
1
4
TITLE OF THIS WORK
PREVIOUS OR ALTERNATIVE TITLES
NATURE OF THIS WORK See instructions
2
YEAR IN WHICH CREATION OF THIS
WORK WAS COMPLETED
This information
must be given
in all cases.
DATE AND NATION OF FIRST PUBLICATION OF THIS PARTICULAR WORK
Complete this information
ONLY if this work
has been published.
COPYRIGHT CLAIMANT(S) Name and address must be given even if the claimant is the same as
the author given in space 2.
TRANSFER If the claimant(s) named here in space 4 is (are) dierent from the author(s) named in
space 2, give a brief statement of how the claimant(s) obtained ownership of the copyright.
Year
ba
Month Day Year
Nation
MORE ON BACK
DO NOT WRITE HERE
Page 1 of pages
Complete all applicable spaces (numbers 5-9) on the reverse side of this page.
• See detailed instructions. • Sign the form at line 8.
DO NOT WRITE HERE
OFFICE USE ONLY
See instructions
before completing
this space.
NAME OF AUTHOR DATES OF BIRTH AND DEATH
Year Born Year Died
NOTE
Under the law,
the “author” of
a “work made
for hire” is
generally the
employer, not
the employee
(see instruc-
tions). For any
part of this
work that was
“made for hire”
check “Yes” in
the space
provided, give
the employer
(or other
person for
whom the work
was prepared)
as “Author” of
that part, and
leave the
space for dates
of birth and
death blank.
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
“work made for hire”?
OR
AUTHOR'S NATIONALITY OR DOMICILE
WAS THIS AUTHOR'S CONTRIBUTION TO
THE WORK
Anonymous? Yes No
Pseudonymous?
Yes No
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
NATURE OF AUTHORSHIP Briey describe nature of material created by this author in which copyright is claimed.
a
NAME OF AUTHOR DATES OF BIRTH AND DEATH
Year Born Year Died
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
“work made for hire”?
OR
AUTHOR'S NATIONALITY OR DOMICILE
WAS THIS AUTHOR'S CONTRIBUTION TO
THE WORK
Anonymous? Yes No
Pseudonymous?
Yes No
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
NATURE OF AUTHORSHIP Briey describe nature of material created by this author in which copyright is claimed.
b
NAME OF AUTHOR DATES OF BIRTH AND DEATH
Year Born Year Died
Name of Country
Citizen of
Domiciled in
{
Was this contribution to the work a
“work made for hire”?
OR
AUTHOR'S NATIONALITY OR DOMICILE
WAS THIS AUTHOR'S CONTRIBUTION TO
THE WORK
Anonymous? Yes No
Pseudonymous?
Yes No
If the answer to either
of these questions is
“Yes,” see detailed
instructions.
NATURE OF AUTHORSHIP Briey describe nature of material created by this author in which copyright is claimed.
c
APPLICATION RECEIVED
ONE DEPOSIT RECEIVED
TWO DEPOSITS RECEIVED
FUNDS RECEIVED
Yes
No
Yes
No
Yes
No
Form PA
3
For a Work of Performing Arts
UNITED STATES COPYRIGHT OFFICE
REGISTRATION NUMBER
PA PAU
EFFECTIVE DATE OF REGISTRATION
Month Day Year
Copyright Ofce fees are subject to change. For
current fees, check the Copyright Ofce website
at www.copyright.gov, write the Copy right Ofce,
or call (202) 707-3000 or 1-877-476-0778 (toll free).
Privacy Act Notice: Sections 408-410 of title 17 of the
United States
Code
authorize the Copyright Ofce 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. It will appear in the Ofce’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 benets
under the copyright law.
Clear Form
DERIVATIVE WORK OR COMPILATION Complete both space 6a and 6b for a derivative work; complete only 6b for a compilation.
Preexisting Material Identify any preexisting work or works that this work is based on or incorporates.
Material Added to This Work Give a brief, general statement of the material that has been added to this work and in which copyright is claimed.
DEPOSIT ACCOUNT If the registration fee is to be charged to a Deposit Account established in the Copyright Oce, give name and number of Account.
Name Account Number
CORRESPONDENCE Give name and address to which correspondence about this application should be sent. Name/Address/Apt/City/State/Zip
Area code and daytime telephone number ( ) Fax number ( )
Email
CERTIFICATION* I, the undersigned, hereby certify that I am the
of the work identied in this application and that the statements made by me in this application are correct to the best of my knowledge.
Typed or printed name and date If this application gives a date of publication in space 3, do not sign and submit it before that date.
Date
Signature (X)
5
7
6
EXAMINED BY
CHECKED BY
CORRESPONDENCE
Yes
FORM PA
FOR
COPYRIGHT
OFFICE
USE
ONLY
DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET.
PREVIOUS REGISTRATION
Has registration for this work, or for an earlier version of this work, already been made in the Copyright Oce?
Yes No If your answer is “Yes,” why is another registration being sought? (Check appropriate box.) If your answer is No, do not check box A, B, or C.
a.
This is the rst published edition of a work previously registered in unpublished form.
b.
This is the rst application submitted by this author as copyright claimant.
c.
This is a changed version of the work, as shown by space 6 on this application.
If your answer is “Yes,” give Previous Registration Number Year of Registration
Certicate
will be
mailed in
window
envelope
to this
address:
Name
Number/Street/Apt
City/State/Zip
*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.
See instructions
before completing
this space.
YOU MUST:
• Complete all necessary spaces
• Sign your application in space 8
SEND ALL 3 ELEMENTS
IN THE SAME PACKAGE:
1. Application form
2.
Nonrefundable ling fee in check or mon-
ey order payable to U.S. Copyright Ofce
3. Deposit material
MAIL TO:
Library of Congress
Copyright Ofce-PA
101 Independence Avenue SE
Washington, DC 20559-6000
8
a
b
x
a
b
9
author
other copyright claimant
owner of exclusive right(s)
authorized agent of
Name of author or other copyright claimant, or owner of exclusive right(s)
{
Check only one
Form PA Full Printed: 05/2019 Printed on recycled paper