Form Pto Sb 06 PDF Details

In order to be considered for a paid family and medical leave (PFML) benefit, you must complete Form PTO SB 06. This form is used to request workers' compensation benefits related to your own illness or injury, or to request benefits for care of an ill or injured family member. The form can be completed either electronically or on paper, and must be submitted within 30 days of the date you became unable to work. Completing the form accurately and fully will help ensure that you receive the benefits you are entitled to.

QuestionAnswer
Form NameForm Pto Sb 06
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesWFEE, PTO-875, AMENDMENTA, OMB

Form Preview Example

Doc Code: WFEE

Document Description: Fee Worksheet (PTO-875)

PTO/SB/06 (03-13)

Approved for use through 01/31/2014. 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.

PATENT APPLICATION FEE DETERMINATION RECORD

Application or Docket Number

 

Substitute for Form PTO-875

 

APPLICATION AS FILED - PART I

LARGE ENTITY

MICRO ENTITY

SMALL ENTITY

(Column 1)

(Column 2)

 

 

 

FOR

NUMBER FILED

 

NUMBER EXTRA

 

 

 

 

BASIC FEE

N/A

 

N/A

(37 CFR 1.16(a), (b), or (c))

 

 

 

 

SEARCH FEE

N/A

 

N/A

(37 CFR 1.16(k), (i), or (m))

 

 

 

 

 

 

 

 

EXAMINATION FEE

N/A

 

N/A

(37 CFR 1.16(o), (p), or (q))

 

 

 

 

 

 

 

 

TOTAL CLAIMS

 

 

*

(37 CFR 1.16(i))

minus 20

=

 

 

 

 

INDEPENDENT CLAIMS

minus 3

=

*

(37 CFR 1.16(h))

 

 

 

 

If the specification and drawings exceed 100

APPLICATION SIZE

sheets of paper, the application size fee due

FEE

is $310 ($155 for small entity) for each

(37 CFR 1.16(s))

additional 50 sheets or fraction thereof. See

 

35 U.S.C. 41(a)(1)(G) and 37 CFR 1.16(s).

MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1.16()))

* If the difference in column 1 is less than zero, enter "0" in column 2.

RATE ($)

FEE ($)

 

N/A

N/A

N/A

X=

X=

N/A

TOTAL

APPLICATION AS AMENDED - PART II

 

 

(Column 1)

 

(Column 2)

(Column 3)

 

 

 

 

 

 

 

 

 

CLAIMS

 

HIGHEST

 

AMENDMENTA

 

REMAINING

 

NUMBER

PRESENT

 

AFTER

 

PREVIOUSLY

EXTRA

 

 

 

 

 

AMENDMENT

 

PAID FOR

 

 

Total

*

 

Minus

**

=

 

(37 CFR 1.16(i))

 

 

 

 

 

 

 

 

 

 

 

 

 

Independent

*

 

Minus

***

=

 

(37 CFR 1.16(h))

 

 

 

 

 

 

 

 

 

 

 

 

 

Application Size Fee (37 CFR 1.16(s))

 

 

 

 

 

FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.16()))

 

 

 

 

 

 

 

 

(Column 1)

 

(Column 2)

(Column 3)

 

 

CLAIMS

 

 

HIGHEST

 

AMENDMENTB

 

REMAINING

 

 

NUMBER

PRESENT

 

AFTER

 

 

PREVIOUSLY

EXTRA

 

 

 

 

 

 

AMENDMENT

 

 

PAID FOR

 

 

Total

*

 

Minus

**

=

 

(37 CFR 1.16(i))

 

 

 

 

 

 

 

 

 

 

 

 

 

Independent

*

 

Minus

***

=

 

(37 CFR 1.16(h))

 

 

 

 

 

 

 

 

 

 

 

 

Application Size Fee (37 CFR 1.16(s))

 

 

 

 

 

FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.16()))

 

 

 

 

 

 

 

LARGE ENTITY

 

 

MICRO ENTITY

SMALL ENTITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RATE ($)

 

 

ADDI-

 

 

 

 

TIONAL

 

 

 

 

FEE ($)

 

X

=

 

 

 

 

 

 

 

 

 

 

 

 

X

=

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

 

 

ADD'L FEE

 

 

 

 

 

 

 

 

 

 

 

 

RATE ($)

 

 

ADDI-

 

 

 

 

TIONAL

 

 

 

 

FEE ($)

 

X

=

 

 

 

 

 

 

 

 

 

 

 

 

X

=

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N/A

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

 

 

ADD'L FEE

 

 

 

 

 

 

 

 

 

 

 

 

*If the entry in column 1 is less than the entry in column 2, write "0" in column 3.

**If the "Highest Number Previously Paid For" IN THIS SPACE is less than 20, enter "20".

***If the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter "3".

The "Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in column 1.

This collection of information is required by 37 CFR 1.16. 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 12 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 sub)ect 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 sub)ect 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, sub)ect 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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How to complete CFR part 1

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Stage no. 2 in submitting CFR

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