Form PTO/SB/124 Request for Customer Number Data Change

Doc Code:

PTO/SB/124A (12-08)
Approved for use through XX/XX/XXXX. OMB Control Number 0651-0035
U.S. Patent and Trademark Office; 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.

Address to:

Request for
Customer Number
Data Change

Mail Stop EBC
Commissioner for Patents
P.O. Box 1450
Alexandria, VA 22313-1450

To the Commissioner for Patents:
Please record the following data changes to Customer Number:

Please change Address to:
Firm or
Individual
Name
Address
City

State

Zip

Country
Email

Telephone

Please delete the following practitioner registration number(s) from the Customer Number indicated above:

Please add the following practitioner registration number(s) to the Customer Number above:

Additional practitioner registration numbers are listed on supplemental sheet(s) attached hereto (PTO/SB/124B or equivalent)

Request Submitted by: (must be a person, e.g. registered practitioner, associated with the customer number shown above)
Firm Name (if applicable)
Signature
Name of Person
Submitting request
Telephone Number

Registration
No.

Date

This collection of information is required by 37 CFR 1.33. The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO
to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This information collection is estimated to take 12 minutes
to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the
individual case. Any comments on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to
the Office of the Chief Administrative Officer, U.S. Patent and Trademark Office P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES
OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Mail Stop EBC, Commissioner for Patents, P.O. Box 1450, Alexandria, VA

22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 (1-800-786-9199) and select option.

PTO/SB/124B (12-08)
Approved for use through XX/XX/XXXX. OMB Control Number 0651-0035
U.S. Patent and Trademark Office; 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.

Request for
Customer Number
Data Change

Practitioner Registration Number
Supplemental Sheet
Page

of

Pages

To the Commissioner for Patents:
Please record the following data
Changes to Customer Number:
Please delete the following practitioner registration number(s) from the Customer Number indicated above:

Please add the following practitioner registration number(s) to the Customer Number indicated above:

Firm Name
Date

Additional supplemental sheet(s) attached hereto

This collection of information is required by 37 CFR 1.33. The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO
to process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This information collection is estimated to take 12 minutes
to complete, including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the
individual case. Any comments on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to
the Office of the Chief Administrative Officer, U.S. Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND
FEES OR COMPLETED FORMS TO THIS ADDRESS. SEND TO: Mail Stop EBC, Commissioner for Patents, P.O. Box 1450, Alexandria, VA

22313-1450.
If you need assistance in completing the form, call 1-800-PTO-9199 (1-800-786-9199) and select option 2.

Privacy Act Statement
The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with your
submission of the attached form related to a patent application or patent. The United States Patent and Trademark
Office collects this information under authority of 37 CFR 1.33. This information is covered by a System of Records
Notice which identifies the categories of individuals covered by the system including inventors, legal representatives for
inventors, and other persons authorized by law to make applications for patent. The information in this system of
records is used to manage all records of applicants and legal representatives including name, citizenship, residence,
post office address and other information pertaining to activities in connection with the invention for which a patent is
sought.
The information obtain is protected from disclosure to third parties in accordance with the Privacy Act. However, routine
uses of this information may include disclosure to the following: to law enforcement and investigation in the event that
the system of records indicates a violation or potential violation of law; to a Federal, state, local, or international
agency, in response to its request; to an agency, organization, or individual for the purpose of performing audit or
oversight operations as authorized by law; to non-federal personnel under contract to the agency; to a court for
adjudication and litigation; to the Department of Justice for Freedom of Information Act assistance; to members of
congress working on behalf of an individual; to the Office of Personnel Management for personnel research purposes;
to National Archives and Records Administration for inspection of records; and to the Office of Management and
Budget for legislative coordination and clearance. Failure to provide any part of the requested information may result in
an inability to process requests for access and information. The applicable Privacy Act System of Records Notice for
this information is COMMERCE/PAT-TM-7 Patent Application Files, available at Federal Register /Vol. 78, No. 61 /
Friday, March 29, 2013 /Notices 19243. https://www.govinfo.gov/content/pkg/FR-2013-03-29/
pdf/2013-07341.pdf