|
National Aeronautics and Space Administration |
Disclosure of Invention and New Technology (Including Software) |
Form Approved O.M.B. NO. 2700-0009 |
DATE
|
||||||||||
CONTRACTOR CASE NO.
|
||||||||||||||
This is an important legal document. Carefully complete and forward to the Patent Representative (NASA in-house innovation) or New Technology Representative (contractor/grantee innovation) at NASA. Use of this report form by contractor/grantee is optional; however, an alternative format must |
NASA CASE NO. (OFFICIAL USE ONLY)
|
|||||||||||||
at a minimum contain the information required herein. NASA in-house disclosures should be read, understood and signed by a technically competent witness in the witness signature block at the end of this form. In completing each section, use whatever detail deemed appropriate for a “full and complete disclosure.” Contractors/Grantees please refer to the New Technology or Patent Rights – Retention by the Contractor clauses. When necessary, attach additional documentation to provide a full, detailed description. |
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
Innovator #1 Innovator #3
Innovator #2 Innovator #4
GE = Government CU = College or University NP = Non-Profit Organization SB = Small Business Firm LE = Large Entity |
|
|||||||||||||
NASA In-house Org. Mail Code Grant/Cooperative Agreement No. Prime Contract No. Task No. Report No. Subcontractor; Subcontract Tier Joint Effort (contractor, subcontractor and/or grantee contribution(s), and NASA in-house contribution) Multiple Effort (multiple contractor, subcontractor and/or grantee contributions, no NASA in-house contribution) Other (e.g., Space Act Agreement, MOA) No. |
WBS WBS
WBS
WBS
|
|||||||||||||
|
|
|||||||||||||
|
||||||||||||||
NASA
FORM 1679 DEC
2007 PREVIOUS EDITION IS OBSOLETE. Page
|
||||||||||||||
SECTION I – DESCRIPTION OF THE PROBLEM OR OBJECTIVE THAT MOTIVATED THE INNOVATION’S DEVELOPMENT (Enter as appropriate: A. – General description of problem/objective; B. – Key or unique problem characteristics; C. – Prior art, i.e., prior techniques, methods, materials, or devices performing function of the innovation, or previous means for performing function of software; and D. – Disadvantages or limitation of prior art.)
|
||||||||||||||
SECTION II – TECHNICALLY COMPLETE AND EASILY UNDERSTANDABLE DESCRIPTION OF INNOVATION DEVELOPED TO SOLVE THE PROBLEM OR MEET THE OBJECTIVE (Enter as appropriate; existing reports, if available, may form a part of the disclosure, and reference thereto can be made to complete this description: A. – Purpose and description of innovation/software; B. – Identification of component parts or steps, and explanation of mode of operation of innovation/software preferably referring to drawings, sketches, photographs, graphs, flow charts, and/or parts or ingredient lists illustrating the components; C. – Functional operation; D. – Alternate embodiments of the innovation/software; E. – Supportive theory; F. – Engineering specifications; G. – Peripheral equipment; and H. – Maintenance, reliability, safety factors.)
|
||||||||||||||
NASA
FORM 1679 DEC
2007 PREVIOUS EDITION IS OBSOLETE. Page
|
||||||||||||||
SECTION III – UNIQUE OR NOVEL FEATURES OF THE INNOVATION AND THE RESULTS OR BENEFITS OF ITS APPLICATION (Enter as appropriate: A. – Novel or unique features; B. – Advantages of innovation/software; C. – Development or new conceptual problems; D. – Test data and source of error; E. – Analysis of capabilities; and F. – For software, any re-use or re-engineering of existing code, use of shareware, or use of code owned by a non-federal entity.)
|
||||||||||||||
SECTION IV – SPECULATION REGARDING POTENTIAL COMMERCIAL APPLICATIONS AND POINTS OF CONTACT (Including names of companies producing or using similar products.)
|
||||||||||||||
NASA FORM 1679 DEC 2007 PREVIOUS EDITION IS OBSOLETE. Page 3 of 4
|
||||||||||||||
TITLE PAGE DATE
|
||||||||||||||
Modification to Existing Technology Substantial Advancement in the Art Major Breakthrough |
||||||||||||||
Concept Only Design Prototype Modification Production Model Used in Current Work |
||||||||||||||
Application Filed Application No. Application Date Patent Issued Patent No. Issue Date |
||||||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
(b) Modification of this program continued by civil servant and/or contractual agreement? YES NO (c) Copyright registered? YES NO UNKNOWN If Yes, then by whom? (d) Has the latest version been distributed outside of NASA or contractor? YES NO UNKNOWN If Yes, date of first disclosure: (e) Were prior versions distributed outside of NASA or Contractor? YES NO If Yes, supply NASA or contractor contract: (f) Contains or based on code not owned by U.S. Government or its contractors? YES NO UNKNOWN If Yes, name of code and code’s owner: Has a license for use been obtained? YES NO UNKNOWN |
||||||||||||||
|
||||||||||||||
STAGE OF DEVELOPMENT |
DATE (MM/YYYY) |
LOCATION |
IDENTIFY SUPPORTING WITNESSES (NASA in-house only) |
|||||||||||
|
|
|
|
|||||||||||
|
|
|
|
|||||||||||
|
|
|
|
|||||||||||
|
|
|
|
|||||||||||
|
|
|
|
|||||||||||
|
||||||||||||||
|
||||||||||||||
|
||||||||||||||
TYPED NAME AND SIGNATURE (Innovator #1)
|
DATE
|
TYPED NAME AND SIGNATURE (Innovator #2)
|
DATE
|
|||||||||||
TYPED NAME AND SIGNATURE (Innovator #3)
|
DATE
|
TYPED NAME AND SIGNATURE (Innovator #4)
|
DATE
|
|||||||||||
TYPED NAME AND SIGNATURE (Witness #1)
|
DATE
|
TYPED NAME AND SIGNATURE (Witness #2)
|
DATE
|
|||||||||||
|
TYPED |
SIGNATURE |
DATE
|
|||||||||||
NASA FORM 1679 DEC 2007 PREVIOUS EDITION IS OBSOLETE. Page 4 of 4
|
File Type | application/msword |
File Title | NF 1679 Disclosure of Invention and New Technology |
Author | Commercial Technology |
Last Modified By | LMIT-ODIN |
File Modified | 2007-12-20 |
File Created | 2007-12-20 |