Fillable Dd Form 882 - Report Of Inventions And Subcontracts

REPORT OF INVENTIONS AND SUBCONTRACTS

Form Approved

OMB No. 9000-0095

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

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

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

1.a. NAME OF CONTRACTOR/SUBCONTRACTOR

2.a. NAME OF GOVERNMENT PRIME CONTRACTOR

c. CONTRACT NUMBER

3. TYPE OF REPORT

(X one)

a. INTERIM

b. FINAL

b. ADDRESS (Include ZIP Code)

d. AWARD DATE

b. ADDRESS (Include ZIP Code)

d. AWARD DATE

4. REPORTING PERIOD (YYYYMMDD)

(YYYYMMDD)

a. FROM

b. TO

SECTION I - SUBJECT INVENTIONS

5. "SUBJECT INVENTIONS" REQUIRED TO BE REPORTED BY CONTRACTOR/SUBCONTRACTOR

(If "None," so state)

ELECTION TO FILE

CONFIRMATORY INSTRUMENT

DISCLOSURE NUMBER,

PATENT APPLICATIONS (X)

OR ASSIGNMENT FORWARDED

NAME(S) OF INVENTOR(S)

TITLE OF INVENTION(S)

PATENT APPLICATION

TO CONTRACTING OFFICER (X)

(Last, First, Middle Initial)

SERIAL NUMBER OR

(1) UNITED STATES

(2) FOREIGN

PATENT NUMBER

(a) YES

(b) NO

(a) YES

(b) NO

(a) YES

(b) NO

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

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

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

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

(1) TITLE OF INVENTION

(2) FOREIGN COUNTRIES OF PATENT APPLICATION

(b) NAME OF EMPLOYER

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

6. SUBCONTRACTS AWARDED BY CONTRACTOR/SUBCONTRACTOR

(If "None," so state)

FAR "PATENT RIGHTS"

SUBCONTRACT DATES (YYYYMMDD)

NAME OF SUBCONTRACTOR(S)

SUBCONTRACT

DESCRIPTION OF WORK TO BE PERFORMED

ADDRESS (Include ZIP Code)

NUMBER(S)

UNDER SUBCONTRACT(S)

(1) CLAUSE

(2) DATE

(2) ESTIMATED

(1) AWARD

NUMBER

(YYYYMM)

COMPLETION

SECTION III - CERTIFICATION

7. CERTIFICATION OF REPORT BY CONTRACTOR/SUBCONTRACTOR

SMALL BUSINESS or

NONPROFIT ORGANIZATION

(Not required if: (X as appropriate))

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

b. TITLE

c. SIGNATURE

d. DATE SIGNED

OFFICIAL (Last, First, Middle Initial)

DD FORM 882, JUL 2005

PREVIOUS EDITION IS OBSOLETE.

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