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    Generate Inventor Certification Form


  1. From the Welcome to iEdison page, select NIH to access the NIH Extramural Invention Topics page.
  2. Select NIH Procedures for Waiving an Invention to the Inventor to access the Processing of Requests for Assignment of Invention Rights to the Inventor page.
  3. Select inventor certification to access the Manage Inventor Waiver - Inventor Certification Form page.
  4. Enter the inventor certification information, noting the following:
    • Fields with an asterisk (*) are required.
  5. Click Submit.
  6. A view-only version of the inventor certification information is displayed.
  7. Click Print this form.
  8. A printable version of the inventor certification is displayed with the information you entered filled in.
  9. Print, sign, and fax the form to the NIH at (301) 480-0272.
  Field Definitions
Grantee/Contractor Organization

The full name of the Extramural Grantee or Contractor Organization.

This includes all recipients of federal funding whether by grant, contract, or cooperative agreement, as well as sub awardees (regardless of tier) for any of the above types of agreements (e.g., subgrant, subcontract) if performing research, developmental, or experimental work.

Grant/Contract Number

The grant/contract number associated with the invention for which a waiver is requested.

Invention Report Number

The Invention Report number is automatically generated by the iEdison system for a new Invention Report when the data has been submitted, checked for errors, and verified. Once the Invention Report has been created, the Invention Report number may not be modified by the organization. Reference should be made to the Invention Report number in all correspondence with the awarding agency.

The Invention Report number can contain up to 18 characters. The first 7 characters, before the dash, may vary in length from 4, 5, 6, or 7 values. However, the second half (##-####) must contain values. The complete format for the field is: ##########-##-####.

NOTE: If an waiver request is made by mail, please contact iEdison User Support at (301) 435-1986 or 1-866-504-9552 (toll-free) to ensure that all documents are in order to ensure timely processing and to obtain an Invention Report number for the invention.

Invention Title

The title reflects the title of the invention as it appears in the Invention Report.

For the purposes of tracking the waiver request, the invention title stated in any correspondence that relates to the waiver request should match the precise title of the invention as it appears in the iEdison Invention Report record.

Inventors

The inventor fields reflect the full name of each inventor associated with the invention. Any combination of upper- and lower-case letters may be used.

Prefix (e.g. Dr., Ms., Rev.)

The prefix to the name of the inventor.

First Name The first name of the inventor.
Middle Name The middle name or initial of the inventor.
Last Name

The last name of the inventor.

Suffix (e.g. Jr., Nobel)

Any suffix to the name of the inventor.

Address [Address information not required, however, if you do supply one, all fields with a ^ are required]

The address associated with the inventor. The address is composed of four street address lines, city, state, zip, and country

Note: Address information is not required. However, if any address information is supplied, all fields with a ^ next to them become required. This includes: Address Line 1, City, State, Zip, and Country.

E-mail Address

The e-mail address of the inventor.

The format for this field is test@test.com.

Phone

The phone number of the inventor.

The format of this field is: (123) 456-7890 in countries using the North American Numbering Plan, including the U.S., Canada, and most of the Caribbean. Other countries use the country code, followed by the city code and number (e.g., +44 023422).

Patent Filing Application Date

The filing date of the patent application.

The format for this field is: mm/dd/yyyy.

U.S. Serial Number

The U.S. serial number associated with this invention.

Date of Presentation

The date of presentation at a conference or symposium on which the invention was disclosed.

The format for this field is: mm/dd/yyyy.

Date of Submission

The date of submission for the article concerning this invention.

The format for this field is: mm/dd/yyyy.

Date of Acceptance

The date of acceptance for the article concerning this invention.

The format for this field is: mm/dd/yyyy.

Date of Publication

The date of publication for the article concerning this invention.

The format for this field is: mm/dd/yyyy.

Publication Pending

Any pending publications concerning this invention.

Citation

Any citations concerning this invention.


    See Also

Generate Confirmatory License
Generate Inventor Waiver Request Form
Generate Third Party Assignment Request
Generate U.S. Manufacturing Waiver Request Form

 

 

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