Change of Correspondence Address Application

Legal Form NumberAIA/122
CourtUnited States Patent and Trademark Office
SectionUnited States Patent and Trademark Office
PTO/AIA/122 (05-23)
Approved for use through 09/30/2025. OMB 0651-0035
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMER CE
Under the Paperwork Reduction Act of 1995, no pers ons are required to respond to a collection of in formation unless it displays a valid OMB control number.
Address to:
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450
Application Number
Filing Date
First Named Inventor
Art Unit
Examiner Name
Attorney Docket Number
Please change the Correspondence Address for the above-identified patent application to:
The address associated with Customer Number:
Firm or
Individual Name
City State Zip
Telephone Email
This form cannot be used to change the data associated with a Customer Number. To change the
data associated with an existing Customer Number use “Request for Customer Number Data Change” (PTO/SB/124).
I am the:
Typed or Printed
Date Telephone
NOTE: This form must be signed in accordance with 37 CFR 1.33. See 37 CFR 1.4(d) for signature requirements and certifications.
Submit multiple forms if more than one signature is required, see below*.
*Total of ____________ forms are submitted.
A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an
information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a currently valid OMB Control
Number. The OMB Control Number for this information collection is 0651-0035. Public burden for this form is estimated to average 3 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this
burden to the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. If filing this completed form by mail, 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.
Attorney or agent of record. Registration Number ____________________.
Registered practitioner named in the application transmittal papers who acts in a
representative capacity under 37 CFR 1.34. See 37 CFR 1.33(a)(1).
Registration Number ____________________.

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