# Blank invention disclosure form

Educational intake starting point for your organization's counsel to adapt. Completing this form does not establish inventorship, ownership, patentability, or readiness to file. Legal assessment depends on the matter and jurisdiction. This form has not received matter-specific counsel review.

Type directly into the response areas and add rows or pages as needed. Ordinary editable text and tables are used, with no password protection or macros. Record exact dates where known and label estimates. Use unknown, not provided, pending, or not applicable instead of guessing. Use none only when supported by the relevant facts. Keep confidential material in your organization's approved intake environment.

## 1. Record and contact

Title, internal record ID, project, submitter, work contact, submission date, version, and internal access designation.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 2. Technical problem

What failed or limited the current approach? Describe the operating environment, baseline, and constraints.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 3. Technical solution and operation

Identify components or process steps, inputs, interfaces, parameters, outputs, and failure behavior. Explain the sequence in enough detail for a technical discussion.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 4. Candidate distinguishing features

What specific differences does the team see relative to its known baseline? Separate observed results from expected benefits. Add a source locator for each difference.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 5. Embodiments and alternatives

Describe the implemented version, necessary and optional elements, substitutes, and other uses. Label each version tested, proposed, or speculative.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 6. People and contributions

For each person, record name, employer or affiliation, work contact, technical contribution or activity, date, and source. Separately identify people for counsel to consider as possible inventors.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 7. Development chronology

Record important design, build, test, and revision events, their dates and locations, and supporting record owners. Identify approximate or disputed dates.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 8. Evidence and limitations

Record test setup, measured results, failed cases, untested conditions, and attachment locations. State what the evidence does and does not support.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 9. Known related work

List known products, publications, patent documents, or internal approaches, with identifiers and relevant passages. Record any search already performed and its scope, or state that no search is reported.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 10. Business, funding, and agreements

Intended use, development plans, business owner, known sponsors or grants, outside collaborators, third-party materials, and agreement references. Record unresolved funding or rights context.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 11. Actual and planned external events

For every publication, presentation, demonstration, sale, offer, customer discussion, or other release: date, recipients, channel, material shared, access restrictions, and known confidentiality-agreement reference. Include planned events.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 12. Source register and missing information

Assign each attachment an ID, version, owner, and page or section locator. For every gap, record the question, answer owner, needed record, and follow-up date.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

## 13. Factual confirmation and counsel handoff

Record each contributor's factual confirmation, corrections, and limits. Identify the counsel recipient, handoff date, questions requiring legal review, and authorized next step.

**Response:** [Enter response]

**Source ID and locator:** [Enter record, version, page or section]

**Unknowns, conflicts, or follow-up:** [Enter details or supported not applicable]

### Possible inventors for counsel to consider

[Enter names and reasons for consideration. Keep this tentative list separate from the broader contributor roster. No legal inventorship determination is made by this list.]

## Contributor roster

| Name, employer/affiliation, and work contact | Technical contribution or activity | Date and source locator | Factual confirmation, date, and limits |
| --- | --- | --- | --- |
| [Enter] | [Enter] | [Enter] | [Enter] |

## Development chronology

| Date and exact/estimated status | Design, build, test, or revision event and location | Source ID and locator | Record owner |
| --- | --- | --- | --- |
| [Enter] | [Enter] | [Enter] | [Enter] |

## Actual and planned external events

| Date and actual/planned state | Recipients and channel | Exact material shared or proposed; access restrictions | Known agreement reference or unknown; source locator |
| --- | --- | --- | --- |
| [Enter] | [Enter] | [Enter] | [Enter] |

## Source register

| Source ID | Record title, version, and date | Owner and approved storage location | Field supported and exact page/section locator |
| --- | --- | --- | --- |
| [Enter] | [Enter] | [Enter] | [Enter] |

## Missing-information checklist and open-question log

| Field and unknown/conflicting point | Question and needed record | Answer owner | Requested response date and state |
| --- | --- | --- | --- |
| [Enter] | [Enter] | [Enter] | [Enter] |

## Individual factual-confirmation record

| Name and date | Facts reviewed and knowledge limits | Corrections and unresolved questions | Confirmation recorded/pending; signature if required by organizational policy |
| --- | --- | --- | --- |
| [Enter] | [Enter] | [Enter] | [Enter] |

## Counsel-handoff record

| Counsel recipient and handoff date | Reviewed form/source versions and review state | Contribution, disclosure, agreement, and jurisdiction questions | Authorized next task, recipient, scope, and remaining limits |
| --- | --- | --- | --- |
| [Enter] | [Enter] | [Enter] | [Enter] |

## Reusable factual-confirmation statement

> I have reviewed the technical description, my recorded contribution, and the development and disclosure events within my knowledge. My corrections and uncertainties are recorded in the open-question log. This confirmation concerns factual accuracy, not a legal inventorship determination.

This intake confirmation is separate from an application-stage inventor oath or declaration.

## Recommended organizational review sequence

1. Obtain factual confirmations from each proposed inventor and relevant contributor, including corrections and knowledge limits.
2. Send the versioned form, sources, confirmation record, gap log, and actual/planned external-event details to patent counsel. Flag imminent events immediately even when technical responses remain incomplete.
3. Record counsel review and the scoped next assignment before commissioning prior-art analysis or application drafting under this organizational process.

These are recommended organizational controls, not a universal legal prerequisite or an enforced platform gate. Record event dates for counsel without calculating a universal filing deadline. Patent counsel retains legal review and decision authority.