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Public reporting burden for this collection of Information is estimated to avenge 1 hour per response, including the time for reviewing Instruction searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information Send commenta regering the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (VRS). Once al Federal Acquisition and Regulatory Policy. GSA, Washington, D.C. 20406; and to the Omce of Management and Budget, Paperwort Reduction Project (2106-0817). Washington, D.C. 20603.

Pursuant to the terms of Contract No.

and in consideration of the reimbursement of costs and payment of fee, as provided in the said contract and any assignment thereunder,

(hereinafter called the Contractor) does hereby:

1. Assign, transfer, set over the release to the UNITED STATES OF AMERICA (hereinafter called the Government), all right, title and interest to all refunds, rebates, credits or other amounts (including any interest thereon) arising out of the performance of the said contract, together with all the rights of action accrued or which may hereafter accrue thereunder.

2. Agree to take whatever action may be necessary to effect prompt collection of all refunds, rebates, credits or other amounts (including any interest thereon) due or which may become due, and to promptly forward to the UNITED STATES TREASURER checks (made payable to the Treasurer of the United States) for any proceeds so collected. The reasonable costs of any such action to effect collection shall constitute allowable costs when approved by the Contracting Officer as stated in the said contract and may be applied to reduce any amounts otherwise payable to the Government under the terms hereof.

J. Agree to cooperate fully with the Government as to any claim or suit in connection with refunds, rebates, credits or other amounts due (including any interest thereon); to execute any protest, pleading, application, power of attorney or other papers in connection with; and to permit the Government to represent it at any hearing, trial, or other proceeding arising out out of such claim or suit.

IN WITNESS WHEREOF, this assignment has been executed this

day of

BY:

(CONTRACTOR)

CERTIFICATE

certify that I am the

(official title) of the corporation named as Contractor in the foregoing assigament; that signed said assignment on behalf of the Contractor was then

of said corporation by authority of its governing body and is within the scope of its corporate powers

(CORPORATE SEAL)

OMB Control No. 2105-0$17

CUMULATIVE CLAIM AND
RECONCILIATION STATEMENT

Expiration Date: 130797

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 this burden, to the FAR Secretariat (VRS). Ofico of Federal Acquisition and Regulatory Policy. GSA Washington, D.C. 20406, and to the Office of Management and Budget Paperwork Reduction Project (2106-0617). Washington, D.C. 20503.

1. Name of Contractor
2. Address of Contractor

3. Contract No.
4. Delivery/Task Order No.

5. The total amount claimed under the above numbered contract, delivery order, or task order number is as follows:

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6. Total amount due under the above numbered contract, delivery order, task order is as follows:

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of the above named contractor, certify that the above statements are correct in accordance with the records of the contractor.

(Signature)

For DOT 4 REV. 16) (EXCEL)

PREVIOUS EDITION OBSOLETE

AUTHORIZED FOR LOCAL REPRODUCTION DD FORM 882 INSTRUCTIONS

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GENERAL

This form is for use in submitting INTERIM and FINAL Invention reports to the Contracting Officer and for use in the prompt notification of the award of subcontracts containing a "Patent Rights" clause. If the form does not afford sufficient space, multiple forms may be used or plain sheets of paper with proper identification of information by Item Number may be attached.

Item 2c. 4.7003),

Procurement Instrument Identification (PII) number of contract (DFARS

Item 2d thru 3e. Self-explanatory.

An INTERIM report is due at least every 12 months from the date of contract award and
shall include (a) a listing of "Subject Inventions" during the reporting period, (b) a
certification of compliance with required invention identification and disclosure
procedures together with a certification of reporting of all "Subject Inventions," and (c)
any required information not previously reported on subcontracts awarded during the
reporting period and containing a "Patent Rights" clause.

Item Sf. The name and address of the employer of each inventor not employed by the
contractor or subcontractor is needed because the Government's rights in a reported
invention may not be determined solely by the terms of the "Patent Rights" clause in the

contract

Example 1: If an invention is made by a Government employee assigned to work with a
contractor, the Government rights in such an invention will be determined under
Executive Order 10096.

A FINAL report is due within 6 months if contractor is a small business firm or domestic nonprofit organization and within 3 months for all others after completion of the contract work and shall include (a) a listing of all "Subject Inventions“ required by the contract to be reported, and (b) any required information not previously reported on subcontracts awarded during the course of or under the contract and containing a "Patent Rights" clause

Example 2: If an invention is made under a contract by joint inventors and one of the inventors is a Government employee, the Government's rights in such an inventor's interest in the invention will also be determined under Executive Order 10096, except where the contractor is a small business or nonprofit organization, in which case the provisions of Section 202(e) of P.L. 96-517 will apply.

While the form may be used for simultancously reporting inventions and subcontracts, it
may also be used for reporting, promptly after award, subcontracts containing a "Patent
Rights" clause

Item Sg(1). Self-explanatory,

Dates shall be entered where indicated in certain items on this form and shall be entered in four or six digit numbers in the order of year and month (YYMM) or year, month and day (YYMMDD). Example: April 1986 should be entered as 8604 and April 15, 1986 should be entered as 860415.

Item 5g(2). Self-explanatory with the exception that the contractor or subcontractor shall indicate, if known at the time of this report, whether applications will be filed under either the Patent Cooperation Treaty (PCT) or the European Patent Convention (EPC). If such is known, the letters PCT or EPC shall be entered after each listed country.

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Item 7c. Certification not required by small business firms and domestic nonprofit
organizations.

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