The Privacy Act of 1974 (P.L. 93-579) requires that you be given certain information in connection with the
request for information solicited on attached forms PTO-158 and PTO-275. Accordingly, pursuant to the
requirements of the Act, please be advised that (i) the authority for the collection of this data is 35 U.S. C.
žž1 and 2(b)(2)(D), (ii) furnishing of the information solicited is voluntary, and (iii) the principal purpose for which
the data will be used is to maintain current information relating to your eligibility and fitness for registration to
practice before the United States Patent and Trademark Office in patent cases. If you do not furnish the
requested information, you will not be admitted to the registration examination or registered to practice before
the United States Patent and Trademark Office.
The information provided by you in these forms will be subject to the following routine uses:
1. Information from PTO-158 may be published by the United States Patent and Trademark office in the Official Gazette
to solicit information tending to affect your eligibility on moral, ethical, or other grounds for registration pursuant
to 37 CFR ž 11.7. Information from PTO-275 may be published to provide the public with a roster of registered
practitioners pursuant to 37 CFR 11.11.
2. Disclosure may be made to any Government agency, professional organization, or individual if necessary to
obtain information relevant to an investigation concerning the suitability of an applicant for registration to
practice before the Patent and Trademark Office.
3. Disclosure may be made to a Federal, state, local, foreign, tribal, or other public authority, of the fact that this
system of records contains information relevant to the retention of an employee, retention of a security
clearance, the letting of a contract, or the issuance or retention of a license, grant, or other benefit. The other
agency or licensing organization may then make a request supported by the written consent of the individual
for the entire record if it so chooses. No disclosure will be made unless the information has been determined
to be sufficiently reliable to support a referral to another office within the agency, or to another Federal agency
for criminal, administrative, personnel, or regulatory action.
4. To a court or adjudicative body in a proceeding when: (a) the agency or any component thereof; or (b) any
employee of the agency in his or her capacity, or (c) any employee of the agency in his or her official capacity
where the agency has agreed to represent the employee, or (d) the United States government is a party to
litigation or has an interest in such litigation and by careful review, the agency determines that the records are
both relevant and necessary to the litigation and the use of such records is therefore deemed by the agency
to be for a purpose that is compatible with the purpose for which the agency collected the records.
5. Disclosure may be made to a member of Congress or to a congressional staff member in response to an
inquiry of the Congressional office made at the written request of the constituent about whom the record is
6. Information may be disclosed to the Office of Management and Budget (OMB) in connection with a review of
private relief legislation (as set forth in OMB Circular No. A-19) at any stage of the legislative coordination and
clearance process described in the Circular.
7. The information may be disclosed to the agency contractors, grantees, experts, consultants, or volunteers
who have been engaged by the agency to assist in the performance of a service related to this system of
records and who have need to have access to the records in order to perform the activity. Recipients of
information shall be required to comply with the requirements of the Privacy Act of 1974, as amended,
pursuant to 5 U.S.C. ž 552a(m).
8. The information may be disclosed to the office of Personnel Management (OPM) for personnel research
purposes as a data source for management information, for the production of summary descriptive statistics
and analytical studies in support of the function for which the records are collected and maintained, or for
related manpower studies.
9. Records from this system of records may be disclosed to the National Archives and Records Administration or
to the General Services Administration for records management inspections conducted under 44 U.S.C. žž
2904 and 2906.
10. When a record on its face, or in conjunction with other records, indicates a violation or potential violation of
law, whether civil, or criminal, or regulatory in nature, and whether arising by general statute or particular
program statute, or by regulation, rule, or order, issued pursuant thereto, disclosure may be made to the
appropriate agency, whether Federal, foreign, state, local or tribal, or other public authority responsible for
enforcing, investigating, or prosecuting violations, or charged with enforcing or implementing the stature or
rule, regulation, or order issued pursuant thereto, if the information disclosed is relevant to any enforcement,
regulatory, investigative, or prosecutive responsibility of the receiving entity.