Request for Customer Number Data Change

Representative and Address Provisions

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0651-0035 can be found here:

Documents and Forms

Document Name Document Type
Form PTO/SB/124 Request for Customer Number Data Change Form
PTO/SB/124 Request for Customer Number Data Change sb0124-fill.pdf www.uspto.gov/web/forms/sb0124-fill.pdf Form

Information Collection (IC) Details

IC Title:	Request for Customer Number Data Change	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 37 CFR 1.32 and 1.33

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	PTO/SB/124	Request for Customer Number Data Change	sb0124-fill.pdf	http://www.uspto.gov/web/forms/sb0124-fill.pdf	Yes	Yes	Fillable Fileable Signable

Line of Business: Economic Development

Subfunction: Intellectual Property Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 550

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,000	-400	2,400
Annual IC Time Burden (Hours)	400	-80	480
Annual IC Cost Burden (Dollars)	176	-35	211

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.