Humanitarian Use Form

A pplication

OMB 0651-0066 Approved for use through 7/31/12.

U.S. Patent and Trademark Office; U. S. DEPARTMENT OF COMMERCE

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.

Humanitarian Use Form

Applicant(s): _______________________________________________________________________________

Application Category (select one): ____ Medical ____ Food & Nutrition

____ Clean Technology ____ Information Technology

Instructions: In no more than five pages, please address the following criteria for Humanitarian Use. If your application covers Humanitarian Research, please use the Research form instead.

Humanitarian Use

1. Subject Matter – the applicants’ technology, which is claimed in a U.S. utility patent in force at the time or a pending U.S. utility patent application, effectively addresses a recognized humanitarian issue;

a. What technologies does this application concern? Each technology must be claimed in one or more U.S. utility patents or pending U.S. utility patent applications to be eligible for this program. Please provide all patent or patent application numbers with a brief description of each technology.

b. What recognized humanitarian issues are these technologies (or products derived from these technologies) being used to address?

c. How do these technologies (or products) effectively address these issues? What other remedies for these issues are currently available, and how do these technologies (or products) compare to them?

d. Were all of the patents and patent applications in part (a) either in force or pending during the time of the applicants’ actions described in this application?

2. Target Population – the actions described in this application target an impoverished population affected by the humanitarian issue; and

a. Which populations are your actions described in this application targeting?

b. How do these populations qualify as impoverished?

c. How are these populations affected by the humanitarian issues described in part (i)?

3. Demonstrated Impact – the applicants’ actions have significantly increased application of the technology that benefits the impoverished population by addressing the humanitarian issue.

a. How are the technologies (or products) described in part 1 used by the impoverished populations in part 2(a) to address the humanitarian issues from part 2(c)?

b. What actions have the applicants taken to increase use of the technologies (or products) described in part 3(a) above? Please explain what actions the applicants named on this application have taken themselves, and how those actions (either directly or through further action by other parties) have led to increased use.

It is estimated that the Humanitarian Award Application will take 4 hours to complete. Applying for the Award is voluntary; however, if you apply you must provide the information requested. Failure to provide this information may delay or prevent processing of your application. Please send any comments on the amount of time required to complete this form and/or suggestions for reducing the time burden to the Chief Information Officer, USPTO, PO Box 1450, Alexandria, VA 22313-1450. DO NOT SEND APPLICATIONS TO THIS ADDRESS

Answers

1a.

1b.

1c.

1d.

2a.

2b.

2c.

3a.

3b.

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