Information Collection

0069 Derivation proceeding (petition)

IC 203348 under ICR 201301-0651-003 · OMB 0651-0072.

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IC Title:	0069 Derivation proceeding (petition)	Agency IC Tracking Number:	XXXX

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 42.15(c)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 49	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	49	-1	50
Annual IC Time Burden (Hours)	0	0	0
Annual IC Cost Burden (Dollars)	19,600	-400	20,000

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.