Technology Partnerships OMBudsmen Reporting Requirements

Initial Ombuds Contact
(MMIDD/YYYY)
Ombuds Name

Type [l Consultation ❑ Case
Time Spent
(Hours)

Final Ombuds Involvement
(MMIDD/YYYY)
Laboratory or Facility

❑ AMESLAD El ANL El BJC

❑ BNL

El EML El FEMI El INEEL

❑ KANSAS CITY

El LANL El LBNL L LLNL

❑ NBL

El NETL El NREL El NTS

❑ ORNL

El PANTEX

❑ PNNL El PPPL

❑ SLAC

❑ SNL

❑ SRS

❑ Y12

❑ TJ

Source of Complaint
❑ Private Industry El Self-identified Small Business
F1 Not-for-profit El Private Individual
❑ Lab/Facility Employee El Other
Subject of Complaint
El CRADA

❑ License

El Patent

❑ Non-Fed WFO

El Other
Nature of Complaint
El Policy Interpretation

❑Terms & Conditions

❑ Royalties El Manufacture

OProcedures

❑ Termination

El Ownership

❑ Transfer

Q Unfair Competition

❑ Rights to Intellectual

Issue
❑ Infringement

❑ Expiration

Property
❑ Other
Methodology
L ,Mediated [] Facilitated Negotiations
El Self Resolved El Referred
❑ Other
Status or Outcome
1 A Pending

❑ Withdrawn

El Settled El Unresolved

Optional Case Notes:

Email to : Rod.IsmaytoD_hg.doe.aov
Phone: 202-586-9505