Request For Supplemental Examination Transmittal Form

CourtUnited States Patent and Trademark Office, Patent Trial and Appeal Board
Legal Form NumberSB/59
SectionUnited States Patent and Trademark Office
REQUEST FOR SUPPLEMENTAL EXAMINATION TRANSMITTAL FORM
Address to:
Commissioner for Patents Attorney Docket No.:
P.O. Box 1450
Alexandria, VA 22313-1450 Date:
1.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
This is a request for supplemental examination pursuant to 37 CFR 1.610 of patent number _________________
issued ________________________. 37 CFR 1.610(b)(1).
2. Supplemental examination of claim(s) _______________________________________________is requested.
37 CFR 1.610(b)(4).
3. a. The name(s) of the patent owner(s) (not the patent practitioner(s)) is (are):
b. A submission by the patent owner(s) in compliance with 37 CFR 3.73(c), which establishes that the patent
owner(s) has (have) the entirety of the ownership in the patent for which supplemental examination is
requested, is included. 37 CFR 1.610(b)(9).
4. a. A check in the amount of $____________ is enclosed to cover the fee for processing and treating a
request for supplemental examination, the fee for reexamination ordered under 35 USC 257, and the fee for
processing and treating each non-patent document over 20 sheets in length (37 CFR 1.20(k)(1 - 3));
b. The Director is hereby authorized to charge all applicable fees as set forth in 37 CFR 1.20(k)(1 - 3)
to Deposit Account No. ________________________; or
c. Payment by credit card. Form PTO-2038 is attached. 37 CFR 1.610(a).
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 the credit card account.
6. A copy of the patent for which supplemental examination is requested, and a copy of any disclaimer or
certificate issued for the patent are included. 37 CFR 1.610(b)(6).
7. CD-ROM or CD-R in duplicate, Computer Program (Appendix) or large table
Landscape Table on CD
8. Nucleotide and/or Amino Acid Sequence Submission
If applicable, items a. c. are required.
a. Computer Readable Form (CRF)
b. Specification Sequence Listing on:
i.
ii.
c.
9.
CD-ROM (2 copies) or CD-R (2 copies); or
paper
Statements verifying the identity of above copies
A list of no more than 12 items of information submitted as part of this request is provided in Part B of this form.
Where appropriate, the list must meet the requirements of 37 CFR 1.98(b). 37 CFR 1.605(a), 1.610(b)(2).
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.
PTO/SB/59 (09-16)
Approved for use through 11/30/2024. OMB 0651-0064
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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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 0.3 hours 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
InformationCollection@uspto.gov. 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.

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