Form PTO 450 PTO 450 Pro Bono Survey

PTO 450 (Rev.4/20)
Approved for use through XX/XX/XXXX. OMB 0651-0082
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

Draft Quarterly Metrics Reporting Questionnaire 
Name of Person Reporting Metrics 
Email of Person Reporting metrics 
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What is the name of your regional pro bono program?
Reporting Year
Reporting Quarter
Number of inventor inquiries into your program this quarter?
Number of applicants that applied to your program this quarter (applicants that submit a client
intake form/application)?
a. Of the applicants that applied to your program, provide a breakdown of applicants by
gender, ethnicity, race, and/or veteran status according to the groups identified in the
table below.
Breakdown of applicants applying from each U.S. State [e.g. CA = 35;NV = 6; HI = 2]
List any additional referral sources (other than National Clearing House and direct application to
your program)
Number of applicants placed with an attorney/agent this quarter?
a. Of the applicants placed with and attorney/agent this quarter, provide a breakdown of
applicants by gender, ethnicity, race, and/or veteran status according to the groups
identified in the table below.
Cumulative Backlog [total number of applicants approved for placement but not matched with
an attorney/agent for legal services as of the end of this quarter]
Total number of attorneys agreeing to accept cases as of the last day of this quarter?
Estimated number of hours donated by lawyer referral service panel attorneys serving in your
program this quarter?
Number of provisional patents filed through the program this quarter?
Number of non‐provisional patents filed through the Program this quarter?
Number of design patents filed through the Program this quarter?
Of the applications (provisional, non‐provisional and design) filed through your Program this
quarter, provide a breakdown of the applicants by gender, ethnicity, race, and/or veteran status
according to the groups identified in the table below.
List the patent numbers for the patents that issued this quarter [Patent No are formatted
X,XXX,XXX.  DO NOT LIST patent application numbers which are formatted XX/XXX,XXX]

Requested demographic information of applicants that apply to the Program, applicants that are placed 
with a practitioner, and applicants that file applications.   
Pro Bono 
Applicants 

Applicants 
Matched 

Patent Applications 
Filed 

Sex 
A. Male
B. Female
C. Did not specify
Ethnicity 
D. Hispanic, Latino, or Spanish
origin
E. Did not specify
Race 
F. African American/Black
G. White
H. American Indian or Alaska
Native
I. Asian, Pacific Islander, or
Native Hawaiian
J. Two or more races
K. Did not specify
Other 
L. Veterans

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. Response to this information collection is voluntary; however, the data collected from this survey will be used
for planning efforts to ensure that visits to the public search facility are productive and positive experiences. This survey contains 16
questions and the USPTO estimates that it will take approximately 2 hours to complete this survey and submit to USPTO. Any comments
on the amount of time you require to complete this survey and/or suggestions for reducing this burden, should be sent to the Chief
Administrative Officer, United States Patent and Trademark Office P.O. Box 1450, Alexandria, VA 22313-1450.