Background Info Form

OMB Control Number 0651-0080

Expiration Date: XX/XX/XXXX

Background Information

The United States Patent and Trademark Office (USPTO) is in the process of redesigning our current web based sites and applications, and developing new capabilities for the future. You can gain experience with these new systems prior to their public release and help the USPTO refine their functionality by volunteering to provide feedback.

We are currently asking for volunteers to help with [insert current aspect of project here]

If you are interested, please fill out the following form and we will follow up with you shortly.

1. Name:_____________________

2. Email:_____________________

3. Phone:_____________________

4. Occupation: ______________________

5. Role at work: _____________________

6. I am able to (please select all possibilities): [include only relevant options of current request]

 Visit the USPTO headquarters in person (Alexandria, Virginia)

 Provide feedback via video conference (high speed internet access required)

 Fill out a survey online (internet access required)

 Host a meeting at my workplace where multiple employees are available to provide feedback

7. What USPTO systems do you currently use? (e.g. Electronic Business Center, EFS Web)

System name(s): ________________________________________________________________

______________________________________________________________________________

8. What other systems do you routinely access during your job (non-USPTO)?

System name(s): ________________________________________________________________

______________________________________________________________________________

9. Which USPTO business units do you deal with on a regular basis?

Business unit name(s): ___________________________________________________________

______________________________________________________________________________

10. In general, based on your experience, what do you like about the USPTO systems?

______________________________________________________________________________

11. In general, based on your experience, what do you not like about the USPTO systems?

______________________________________________________________________________

12. Which of the following categories includes your birth year (optional)?

				
Before 1946	1946-1964	1965-1978	1979-1990	After 1990

13. What is the highest level of education you’ve completed (optional)? ____________________

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control Number. The OMB Control Number for this information collection is 0651-0080. Public burden for this focus group is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email InformationCollection@uspto.gov.

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