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Fillable Form Provisional Patent Application

A provisional patent application form allows you to file without a formal patent claim, oath or declaration, or any information disclosure (prior art) statement.

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What is a Provisional Patent Application?

A Provisional Patent Application is a legal form that allows a person to file a legal patent claim, oath, or declaration, or any information disclosure statement. The form primarily contains information on the invention that a patent claim is being made for.

A patent application is a request pending at a patent office for the grant of a patent for an invention described in the patent specification and a set of one or more claims outlined in a formal document. Attached to the document are relevant legal forms and illustrations, flowcharts, datasheets, and others that provide a description and image of the invention in question.

Government agencies typically handle and approve applications for patents. In the United States, the U.S. Patent and Trademark Office (USPTO), which is part of the Department of Commerce, handles applications and grants approvals.

Who needs to use a Provisional Patent Application?

Any person or group of persons who wish to apply for a patent for their invention will need to file an Application for Provisional Patent form.

How to fill out a Provisional Patent Application?

The Provisional Patent Application Template is a very simple form to fill out. Make sure to download the form in PDF before printing it to ensure that all information entered and the format of the form will remain intact even after being printed or otherwise submitted to the relevant person or entity.

Prepare the relevant documents pertaining to the concerned invention. This will help to make sure that all information you enter on this form will be correct and updated. Some documents (particularly illustrations of the invention and flowcharts concerning its development, creation, and operation or use) will also need to be attached to this form.

Invention Title

Enter the title or name given to the invention.


Enter the full legal name of each person involved in the development and creation of the invention.

Field of the Invention

Enter a one sentence statement of what your invention is.

Field of the Invention - Description of the Related Art

Enter a short description of the current state of the field of the invention.


Enter at least two objects or objectives of your invention. Each objective must be explained in only one sentence.

Brief Description of the Drawings

Enter a brief description of each drawing and flowchart attached to this form. Use an extra sheet of paper (clearly marked as an extension of this section) as necessary.

Detailed Description

Enter a detailed description of your invention. Make sure that your description and the details you include in it match the drawings and flowcharts attached to this form. Each element of the invention that is cited here must have an assigned “element number” that corresponds to a particular element in the drawings provided.


Enter the claims you are making for your invention. Each claim must be clear, logical, and precise, and consist of only one sentence each.


Enter an abstract that describes the nature and gist of the invention and how it works. The abstract should not compare the invention to prior art, or refer to speculative applications, purported merits, or any other information that is purely speculative and not based on obtained data.

Provisional Application for Patent Cover Sheet

Express Mail Label Number

Enter the express mail label number assigned to this form.


Enter the following information on each inventor in the columns of the table provided:

  • Given Name
  • Family Name or Surname
  • Residence (City and Other State or Foreign Country)

Then, if more space is required to name more inventors, enter the number of separate and numbered sheets attached to this form that list those additional inventors.

Title of the Invention

Enter the title or name given to the invention.

Address for Further Correspondence

Enter the following information on the address where all further correspondence should be sent to:

  • Address
  • City
  • State
  • ZIP code
  • County
  • Primary Telephone Number
  • Primary Email Address

Enclosed Application Parts

Check each box that applies to the application parts attached to this form. You may check any of the following:

  • Application Data Sheet (See 37 CFR 1.76).
  • Drawing(s). Enter the number of drawing sheets attached to this form.
  • CD(s). Enter the number of CDs attached to this form.
  • Specification (i.e. descriptions of the invention). Enter the number of pages of specifications attached.
  • Other. Specify in the space provided.

Fees Due

This section declares that the filing fee for this form is $260, or $130 for small entities and $65 for micro entities. If the specifications and drawings exceed 100 sheets of paper, an application size fee of $400 ($200 for small entities, $100 for micro entities) will also be due for each additional 50 sheets or fraction thereof.

Method of Payment of the Filing Fee and Application Size Fee for this Provisional Application for Patent

Check one of the following boxes to indicate if you are a small or micro entity. If you are neither, check neither box. You may choose between the following:

  • Applicant asserts small entity status (see CFR 1.27)
  • Applicant certifies micro entity status (see CFR 1.29) (Attach form PTO/SB/15A or B or equivalent to this form).

Then check one of the following boxes that applies to how the filing fee (and any other required fees) will be paid. You may choose one of the following:

  • Check or money order made payable to the Director of the United States Patent and Trademark Office enclosed.
  • Payment by credit card. (Attach Form PTO-2038 to this form).
  • Director is authorized to charge the necessary fees and credit any overpayment to the given deposit account. Enter the deposit account number.

Total Fee Amount ($)

Enter the total fee amount to be paid in US Dollars.

Use only for Filing a Provisional Application for Patent

This section declares that the information on the Provisional Application for Patent form is required to be submitted by 37 CFR 1.51. It states that the collection of the data is estimated to take about 10 hours, and that all inquiries or comments on the amount of time needed to accomplish this form should be sent to the Chief Information Officer at the provided address.

Fees and completed forms should not be sent to the Chief Information Officer, and instead to the Commissioner for Patents at another provided address.

Provisional Application for Patent Cover Sheet

US Government

If the invention was not made by an agency of the US government or under a contract with an agency of the US government, check “No”.

Otherwise, if it was made by an agency of the US government, check “Yes, the invention was made by an agency of the US Government” and enter the name of the US government agency.

If it was made under a contract with an agency of the US government, check “Yes, the invention was made under a contract with an agency of the US government” and enter the name and contact number of the US government agency.


This section warns that personal information such as social security numbers, bank account numbers, and credit card numbers (outside of a check or credit card authorization form submitted for payment purposes) should as much as possible not be included on this form, as such information is not required and the contents of this form will become public after publication of the application barring a non-publication request.


Sign the form in the space provided.

Typed or Printed Name

Enter your full legal name.


Enter your primary telephone number.


Enter the date that this form was signed.

Registration Number

Enter the registration number assigned to you, if applicable.

Docket Number

Enter your docket number.

Privacy Act Statement

This section certifies that you have the right to request and be given information in connection with your submission of the attached form related to a patent application or patent. It also lists all of the ways that the information you provide on this form will be used.

Tips when filling out a Provisional Patent Application

The Provisional Patent Application PDF is a very simple and short form to fill out. However, as it is a legal document that involves the application of a patent for an invention, it is important to ensure that all information entered is accurate and updated in order to avoid any issues that would interfere with your application.

Keep the form in a safe and secure place. Make sure to keep the form in an organized space. This will help to avoid issues that may arise from losing a copy of the form, such as identity theft or the failure of your application to be processed.

Practice good contract management. Create a copy of the accomplished form and store it in a safe and secure area. This will be useful for backup purposes should something happen to the original copy, or for any possible future legal purposes.


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