Appendix F - DD Form 882.pdf

DD FORM 882, JUL 2005

REPORT OF INVENTIONS AND SUBCONTRACTS

(Pursuant to "Patent Rights" Contract Clause) (See Instructions on back)

PREVIOUS EDITION IS OBSOLETE.

Form Approved OMB No. 9000-0095 Expires Jan 31, 2008

The public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (9000-0095). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO THE CONTRACTING OFFICER.

1.a. NAME OF CONTRACTOR/SUBCONTRACTOR

b. ADDRESS (Include ZIP Code)

c. CONTRACT NUMBER

d. AWARD DATE

(YYYYMMDD)

2.a. NAME OF GOVERNMENT PRIME CONTRACTOR

b. ADDRESS (Include ZIP Code)

c. CONTRACT NUMBER

d. AWARD DATE

(YYYYMMDD)

3. TYPE OF REPORT (X one)

a. INTERIM b. FINAL

4. REPORTING PERIOD (YYYYMMDD)

a. FROM

b. TO

SECTION I - SUBJECT INVENTIONS

5. "SUBJECT INVENTIONS" REQUIRED TO BE REPORTED BY CONTRACTOR/SUBCONTRACTOR (If "None," so state) a.

NAME(S) OF INVENTOR(S)

(Last, First, Middle Initial) b.

TITLE OF INVENTION(S)

c.

DISCLOSURE NUMBER,

PATENT APPLICATION

SERIAL NUMBER OR

PATENT NUMBER

d.

ELECTION TO FILE

PATENT APPLICATIONS (X)

(1) UNITED STATES

(a) YES (b) NO

(2) FOREIGN

(a) YES (b) NO e.

CONFIRMATORY INSTRUMENT

OR ASSIGNMENT FORWARDED

TO CONTRACTING OFFICER (X)

(a) YES (b) NO

f. EMPLOYER OF INVENTOR(S) NOT EMPLOYED BY CONTRACTOR/SUBCONTRACTOR

(1) (a) NAME OF INVENTOR (Last, First, Middle Initial)

(b) NAME OF EMPLOYER

(c) ADDRESS OF EMPLOYER (Include ZIP Code)

(2) (a) NAME OF INVENTOR (Last, First, Middle Initial)

(b) NAME OF EMPLOYER

(c) ADDRESS OF EMPLOYER (Include ZIP Code)

g. ELECTED FOREIGN COUNTRIES IN WHICH A PATENT APPLICATION WILL BE FILED

(1) TITLE OF INVENTION (2) FOREIGN COUNTRIES OF PATENT APPLICATION

SECTION II - SUBCONTRACTS (Containing a "Patent Rights" clause)

6. SUBCONTRACTS AWARDED BY CONTRACTOR/SUBCONTRACTOR (If "None," so state) a.

NAME OF SUBCONTRACTOR(S)

b.

ADDRESS (Include ZIP Code) c.

SUBCONTRACT

NUMBER(S)

d.

FAR "PATENT RIGHTS"

(1) CLAUSE

NUMBER

(2) DATE

(YYYYMM)

e.

DESCRIPTION OF WORK TO BE PERFORMED

UNDER SUBCONTRACT(S)

f.

SUBCONTRACT DATES (YYYYMMDD)

(1) AWARD (2) ESTIMATED

COMPLETION

SECTION III - CERTIFICATION

7. CERTIFICATION OF REPORT BY CONTRACTOR/SUBCONTRACTOR (Not required if: (X as appropriate)) SMALL BUSINESS or NONPROFIT ORGANIZATION

I certify that the reporting party has procedures for prompt identification and timely disclosure of "Subject Inventions," that such procedures have been followed and that all "Subject Inventions" have been reported.

a. NAME OF AUTHORIZED CONTRACTOR/SUBCONTRACTOR OFFICIAL (Last, First, Middle Initial)

b. TITLE c. SIGNATURE d. DATE SIGNED

FormFlow/Adobe Professional 6.0

DD FORM 882 INSTRUCTIONS

GENERAL

This form is for use in submitting INTERIM and FINAL invention reports to the Contracting Officer and for use in reporting the award of subcontracts containing a "Patent Rights" clause. If the form does not afford sufficient space, multiple forms may be used or plain sheets of paper with proper identification of information by item number may be attached.

An INTERIM report is due at least every 12 months from the date of contract award and shall include (a) a listing of "Subject Inventions" during the reporting period, (b) a certification of compliance with required invention identification and disclosure procedures together with a certification of reporting of all "Subject Inventions," and (c) any required information not previously reported on subcontracts containing a "Patent Rights" clause.

A FINAL report is due within 6 months if contractor is a small business firm or domestic nonprofit organization and within 3 months for all others after completion of the contract work and shall include (a) a listing of all "Subject Inventions" required by the contract to be reported, and (b) any required information not previously reported on subcontracts awarded during the course of or under the contract and containing a "Patent Rights" clause.

While the form may be used for simultaneously reporting inventions and subcontracts, it may also be used for reporting, promptly after award, subcontracts containing a "Patent Rights" clause.

Dates shall be entered where indicated in certain items on this form and shall be entered in six or eight digit numbers in the order of year and month (YYYYMM) or year, month and day (YYYYMMDD). Example: April 2005 should be entered as 200504 and April 15, 2005 should be entered as 20050415.

1.a. Self-explanatory.

1.b. Self-explanatory.

1.c. If "same" as Item 2.c., so state.

1.d. Self-explanatory.

2.a. If "same" as Item 1.a., so state.

2.b. Self-explanatory.

2.c. Procurement Instrument Identification (PII) number of contract (DFARS 204.7003).

2.d. through 5.e. Self-explanatory.

5.f. The name and address of the employer of each inventor not employed by the contractor or subcontractor is needed because the Government's rights in a reported invention may not be determined solely by the terms of the "Patent Rights" clause in the contract.

Example 1: If an invention is made by a Government employee assigned to work with a contractor, the Government rights in such an invention will be determined under Executive Order 10096.

Example 2: If an invention is made under a contract by joint inventors and one of the inventors is a Government employee, the Government's rights in such an inventor's interest in the invention will also be determined under Executive Order 10096, except where the contractor is a small business or nonprofit organization, in which case the provisions of 35 U.S.C. 202(e) will apply.

5.g.(1) Self-explanatory.

5.g.(2) Self-explanatory with the exception that the contractor or subcontractor shall indicate, if known at the time of this report, whether applications will be filed under either the Patent Cooperation Treaty (PCT) or the European Patent Convention (EPC). If such is known, the letters PCT or EPC shall be entered after each listed country.

6.a. Self-explanatory.

6.b. Self-explanatory.

6.c. Self-explanatory.

6.d. Patent Rights Clauses are located in FAR 52.227.

6.e. Self-explanatory.

6.f. Self-explanatory.

7. Certification not required by small business firms and domestic nonprofit organizations.

7.a. through 7.d. Self-explanatory.

DD FORM 882 (BACK), JUL 2005