PTO/$8106 (10-07)
`Approved for use through 06/30/2010. OMB 0651-0032
`US. Patent and Trademark Ofiice; US. DEPARTMENT OF COMMERCE
`Under the Pa-erwork Reduction Act of 1995, no ersons are re-uired to res'uond to a collection of information unless it disla s a valid OMB control number.
`
`
`PATENT APPLICATION FEE DETERMINATION RECORD
`Applicafi'mr Dme' Number
`Substitute for Form PTO-875
`Z?’
`. o
`
`
` i
`
`OTHER THAN
`
`
`SMALL ENTITY
`
`
`
`
`APPLICATION AS FILED — PART I
`(Column 1)
`(Column 2)
`
`FOR
`BASIC FEE
`
`SEARCH FEE
`
`'
`
`_
`
`NUMBER FILED
`
`NUMBER EXTRA
`
`TOTAL CLAIMS
`(37 CFR 1.16(i))
`
`l
`
`EXAMINATION FEE
`
`V
`
`
`
`
`INDEPENDENT CLAIMS 9 '
`(37 CFR 1.16(h))
`minus 3 =
`
`
`'
`If the specification and drawings exceed 100
`
`APPLICATION SIZE
`
`sheets of paper, the application size fee due
`
`
`FEE
`is $260 ($130 for small entity) for each
`
`
`
`(37 CFR 1.16(s))
`additional 50 sheets or fraction thereof. See
`
`35 U.S.C. 41 a 1 G and 37 CFR 1.16 s.
`
`SMALL ENTITY
`
`0R
`
`RATE 5
`E
`
`E
`
`FEE 5
`
`$165
`$270
`
`X $26:
`
`X $110 =
`
`,
`
`MULTIPLE DEPENDENT CLAIM PRESENT (37 CFR 1.16(j))
`
`.
`
`‘ If the difference in column 1 is less than zero. enter '0' in column 2.
`
`TOTAL
`
`
`HIIIHII!
`
`
`
`
`
`
`
`
`
`
`
`
`RATE 3
`E
`
`E
`
`$270
`
`TOTAL
`
`FEE $
`
`I $540
`
`IlI
`
`O
`
`OTHER THAN
`SMALL ENTITY
`
`
`
`
`
`ADDI-
`TIONAL
`
`ADDI-
`
`TIONAL
`FEE $
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`,
`
`"Y
`
`lV
`
`APPLICATION AS AMENDED — PART II
`
`(Column 2)
`(Column 1)
`HIGHEST
`CLAIMS
`
`REMAINING
`NUMBER
`AFTER
`PREVIOUSLY
`AMENDMENT
`PAID FOR
`
`
`
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`Application Size Fee (37 CFR 1.16(s))
`
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
`
`(Column 1)
`CLAIMS
`REMAINING
`AFTER
`AMENDMENT
`
`(Column 2)
`HIGHEST
`NUMBER
`PREVIOUSLY
`PAID FOR
`
`(Column 3)
`
`PRESENT
`EXTRA
`
`Total
`(31 CFR1.18(i))
`Independent
`(31 CFR1.16(h))
`Application Size Fee (37 CFR 1.113(5))
`FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM (37 CFR 1.160))
`
`
`
`OR
`
`SMALL ENTITY
`
`
`ADDI-
`TIONAL
`
`RATE ($)
`
`X anM0!
`
`II
`
`$195
`TOTAL
`ADD'L FEE
`
`RATE ($)
`
`ADDI-
`TIONAL
`
`X
`
`$26
`
`=
`
`OR
`
`OR
`
`OR
`
`_ 0R
`
`OR
`
`OR
`
`RATE ($)
`
`X $52
`
`= .
`
`X
`
`3220
`
`=
`
`$390
`TOTAL
`ADD'L FEE
`
`RATE ($)
`
`_—
`OR --
`OR
`TOTAL
`ADD'L FEE
`
`ADD'L FEE
`
`
`
`' If the entry in column 1 is less than the entry in column 2, write '0' in column 3.
`" If the “Highest Number Previously Paid For' IN THIS SPACE is less than 20, enter '20'.
`
`"' If the "Highest Number Previously Paid For' IN THIS SPACE is less than 3, enter '3'.
`
`The 'Hi-hest Number Previousl Paid For'
`otal or Inde-endent is the hiohest number found in the an ooron'ate box in column 1.
`
`This collection of information is required by 37 CFR 1.16. 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 1.14. This 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 Chief Information Officer, US. Patent
`and Trademark Ofiice, US. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS
`ADDRESS. SEND TO: Commissioner for Patents, PO. Box 1450, Alexandria, VA 22313-1450.
`
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`If you need assistance in completing the form, call 1-800-PTO—9199 and select option 2.
`
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