Request for Ex Parte Reexamination Transmittal Form

Legal Form NumberSB/57
CourtUnited States Patent and Trademark Office
SectionUnited States Patent and Trademark Office
PTO/SB/57 (11-23)
Approved for use through 11/30/2024. OMB 0651-0064
U.S. Patent and Trademark Office; U.S . DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Ac t of 1995, no persons are required to respond to a collecti on of information unless it displays a valid OMB control num ber.
(Also referred to as FORM PTO-1465)
Address to:
Mail Stop Ex Parte Reexam
Commissioner for Patents Attorney Docket No.:_________________
P.O. Box 1450
Alexandria, VA 22313-1450 Date:______________________
1. This is a request for ex parte reexamination pursuant to 37 CFR 1.510 of patent number _________________
issued ________________________. The request is made by:
patent owner. third party requester.
2. The name and address of the person requesting reexamination is:
3. Requester asserts small entity status (37 CFR 1.27) or certifies micro entity status (37 CFR 1. 29). Only
a patent owner requester can certify micro entity status. Form PTO/SB/15A or B must be attached to certify
micro entity status.
4.This request is accompanied by payment of the reexamination fee as set forth in:
37 CFR 1.20(c)(2); or
37 CFR 1.20(c)(1). In checking this box for payment of the fee set forth in 37 CFR 1.20(c)(1), requester
asserts that this request has forty (40) or fewer pages and complies with all other requirements of
37 CFR 1.20(c)(1).
Payment of the reexamination fee is made by the method set forth below.
A check in the amount of $_______________ is enclosed to cover the reexamination fee;
The Director is hereby authorized to charge the reexamination fee
to Deposit Account No. ________________________;
Payment by credit card. Form PTO-2038 is attached; or
Payment made via USPTO patent electronic filing system.
In addition, the Director is hereby authorized to charge any fee deficiencies to
Deposit Account No. ________________________.
5.Any refund should be made by check or credit to Deposit Account No.__________________.
37 CFR 1.26(c). If payment is made by credit card, refund must be to credit card account.
6. A copy of the patent to be reexamined having a double column format on one side of a separate paper is
enclosed. 37 CFR 1.510(b)(4).
7. CD-ROM or CD-R in duplicate, Computer Program (Appendix) or large table
Landscape Table on CD
[Page 1 of 3]
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 0651-0064. Public burden for this form is estimated to average 18 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.

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