Certificate Self-Recovery Form

Public Key Infrastructure (PKI) Certificate Action Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0045 can be found here:

Documents and Forms

Document Name Document Type
Certificate Self-Recovery Form Form
Certificate Self-Recovery Form onlinerecoverysample.pdf sas.uspto.gov/ptosas Form

Information Collection (IC) Details

IC Title:	Certificate Self-Recovery Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 1.14

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	Certificate Self-Recovery Form	onlinerecoverysample.pdf	https://sas.uspto.gov/ptosas	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records
Title: USPTO PKI Registration and Maintenance System	FR Citation: 65 FR 24178

Number of Respondents: 2,063	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: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,063	2,063
Annual IC Time Burden (Hours)	351	351
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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