Approved for use through 12/31/2009. OMB 0651-0044
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
COMPLAINT REGARDING INVENTION PROMOTER
Instructions: Read the reverse side of this form before completing and submitting the form. Complete as much of the form
as possible and return it to the U.S. Patent and Trademark Office, Mail Stop 24, Commissioner for Patents,
P.O. Box 1450, Alexandria, VA 22313-1450
or fax to (571) 273-0170. Please type or write clearly.
Name of the Invention Promotion Company:
Invention Promoter’s Address:
WHAT IS YOUR COMPLAINT?
Please be as specific as possible within the space provided
Name of mass media invention promoter advertised in: (i.e., TV, Radio, Newspaper, Magazine, Other)
Invention promotion services offered to be performed:
Explanation of complaint between customer and invention promoter:
Signed: ________________________________________ Date: ___________________
Burden Hour Statement: This collection of information is provided for by 35 U.S.C. § 297(d). The information regarding invention promoters will be released to the
public. This form is estimated to take 15 minutes to complete. This time will vary depending upon the needs of the individual case. Any comments on the amount of
time you are required to complete this form should be sent to the U.S. Patent and Trademark Office, Mail Stop Chief Information Officer, P.O. Box 1450,
Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS.
PRIVACY ACT STATEMENT
Section 297 of Title 35, United States Code, authorizes collection of this information. The primary use of
this information is to make complaints publicly available. Additional disclosures will be made to (i)
persons or entities identifi