National Aeronautics and Space Administration




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National Aeronautics and Space Administration

Disclosure of Invention and New Technology (Including Software)

Form Approved

O.M.B. NO.

2700-0009

DATE


     

CONTRACTOR CASE NO.

     


This is an important legal document. Carefully complete and forward to the Patent Representative (NASA in-house innovation) or New Technology Representative (contractor/grantee innovation) at NASA. Use of this report form by contractor/grantee is optional; however, an alternative format must

NASA CASE NO. (OFFICIAL USE ONLY)

     

at a minimum contain the information required herein. NASA in-house disclosures should be read, understood and signed by a technically competent witness in the witness signature block at the end of this form. In completing each section, use whatever detail deemed appropriate for a “full and complete disclosure.” Contractors/Grantees please refer to the New Technology or Patent Rights – Retention by the Contractor clauses. When necessary, attach additional documentation to provide a full, detailed description.

  1. DESCRIPTIVE TITLE   

       

  1. INNOVATOR(S) (For each innovator provide: Name, Title, Work Address, Work Phone Number, and Work E-mail Address. If multiple innovators, number each to match Box 5.)

     

  1. INNOVATOR’S EMPLOYER WHEN INNOVATION WAS MADE (For each innovator provide: Name, Division and Address of Employer, Organizational Code/Mail Code, and Contract/Grant Number if applicable. If multiple innovators, number each to match Box 5.)

     

  1. PLACE OF PERFORMANCE (Address(es) where innovation made)

     

  1. EMPLOYER STATUS (choose
    one for each innovator)




Innovator #1 Innovator #2
     

Innovator #3 Innovator #4


        

GE = Government

CU = College or University

NP = Non-Profit Organization

SB = Small Business Firm

LE = Large Entity



  1. ORIGIN (Check all that apply and provide all applicable numbers. If multiple Contracts/Grants, etc., list Contract/Grant Numbers in Box 3 with applicable employer information.)

 NASA In-house Org. Mail Code      

Grant/Cooperative Agreement No.      

Prime Contract No.      

Task No.       Report No.      

Subcontractor; Subcontract Tier      

Joint Effort (contractor, subcontractor and/or grantee


contribution(s), and NASA in-house contribution)

Multiple Effort (multiple contractor, subcontractor


and/or grantee contributions, no NASA in-house contribution)

Other (e.g., Space Act Agreement, MOA) No.      



WBS      

WBS      

WBS      
WBS      

WBS      



  1. NASA CONTRACTING OFFICER’S TECHNICAL REPRESENTATIVE (COTR)

     


  1. CONTRACTOR/GRANTEE NEW TECHNOLOGY REPRESENTATIVE (POC)

     

  1. BRIEF ABSTRACT (A general description of the innovation which describes its capabilities, but does not reveal details that would enable duplication or imitation of the innovation.)

     


SECTION I – DESCRIPTION OF THE PROBLEM OR OBJECTIVE THAT MOTIVATED THE INNOVATION’S DEVELOPMENT (Enter as appropriate: A. – General description of problem/objective; B. – Key or unique problem characteristics; C. – Prior art, i.e., prior techniques, methods, materials, or devices performing function of the innovation, or previous means for performing function of software; and D. – Disadvantages or limitation of prior art.)
     

SECTION II – TECHNICALLY COMPLETE AND EASILY UNDERSTANDABLE DESCRIPTION OF INNOVATION DEVELOPED TO SOLVE THE PROBLEM OR MEET THE OBJECTIVE (Enter as appropriate; existing reports, if available, may form a part of the disclosure, and reference thereto can be made to complete this description: A. – Purpose and description of innovation/software; B. – Identification of component parts or steps, and explanation of mode of operation of innovation/software preferably referring to drawings, sketches, photographs, graphs, flow charts, and/or parts or ingredient lists illustrating the components; C. – Functional operation; D. – Alternate embodiments of the innovation/software; E. – Supportive theory; F. – Engineering specifications;

G. – Peripheral equipment; and H. – Maintenance, reliability, safety factors.)
     

SECTION III – UNIQUE OR NOVEL FEATURES OF THE INNOVATION AND THE RESULTS OR BENEFITS OF ITS APPLICATION (Enter as appropriate: A. – Novel or unique features; B. – Advantages of innovation/software; C. – Development or new conceptual problems; D. – Test data and source of error; E. – Analysis of capabilities; and F. – For software, any re-use or re-engineering of existing code, use of shareware, or use of code owned by a non-federal entity.)
     

SECTION IV – SPECULATION REGARDING POTENTIAL COMMERCIAL APPLICATIONS AND POINTS OF CONTACT (Including names of companies producing or using similar products.)
     

  1. ADDITIONAL DOCUMENTATION (Include copies or list below any pertinent documentation which aids in the understanding or application of the innovation (e.g., articles, contractor reports, engineering specs, assembly/manufacturing drawings, parts or ingredients list, operating manuals, test data, assembly/manufacturing procedures, etc.).)


TITLE PAGE DATE


     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

  1. DEGREE OF TECHNOLOGY SIGNIFICANCE (Which best expresses the degree of technological significance of this innovation?)

Modification to Existing Technology  Substantial Advancement in the Art  Major Breakthrough

  1. STATE OF DEVELOPMENT

 Concept Only Design Prototype Modification Production Model Used in Current Work

  1. PATENT STATUS (Prior patent on/or related to this innovation.)

Application Filed Application No.       Application Date      

Patent Issued Patent No.       Issue Date      


  1. INDICATE THE DATE OR THE APPROXIMATE TIME PERIOD WHICH THIS INNOVATION WAS DEVELOPED (i.e., conceived, constructed, tested, etc.)

     

  1. PREVIOUS OR CONTEMPLATED PUBLICATION OR PUBLIC DISCLOSURE INCLUDING DATES (Provide as applicable: A. – Type of publication or disclosure, e.g., report, conference or seminar, oral presentation; B. – Disclosure by NASA or Contractor/Grantee; and C. – Title, volume no., page no., and date of publication.)

     

  1. QUESTIONS FOR SOFTWARE ONLY

(a) Using non-NASA employees to beta-test the program? YES NO If Yes, done under a beta-test agreement? YES NO

(b) Modification of this program continued by civil servant and/or contractual agreement? YES NO

(c) Copyright registered? YES NO UNKNOWN If Yes, then by whom?      

(d) Has the latest version been distributed outside of NASA or contractor? YES NO  UNKNOWN

If Yes, date of first disclosure:      

(e) Were prior versions distributed outside of NASA or Contractor? YES NO If Yes, supply NASA or contractor contract:      

(f) Contains or based on code not owned by U.S. Government or its contractors? YES NO  UNKNOWN

If Yes, name of code and code’s owner:      

Has a license for use been obtained? YES NO  UNKNOWN


  1. DEVELOPMENT HISTORY

STAGE OF DEVELOPMENT

DATE

(MM/YYYY)



LOCATION

IDENTIFY SUPPORTING WITNESSES (NASA in-house only)

  1. First disclosure to others

     

     

     

  1. First sketch, drawing, logic chart or code

     

     

     

  1. First written description

     

     

     

  1. Completion of first model of full size device (invention) or beta version (software)

     

     

     

  1. First successful operational test (invention) or alpha version (software)

     

     

     

  1. Contribution of innovators (if jointly developed, provide the contribution of each innovator)

     

  1. Indicate any past, present, or contemplated government use of the innovation

     

  1. SIGNATURES OF INNOVATOR(S), WITNESS(ES), AND NASA APPROVAL

TYPED NAME AND SIGNATURE (Innovator #1)

     


DATE

     


TYPED NAME AND SIGNATURE (Innovator #2)

     


DATE

     


TYPED NAME AND SIGNATURE (Innovator #3)

     


DATE

     


TYPED NAME AND SIGNATURE (Innovator #4)

     


DATE

     


TYPED NAME AND SIGNATURE (Witness #1)

     


DATE

     


TYPED NAME AND SIGNATURE (Witness #2)

     


DATE

     


NASA APPROVED

TYPED
NAME      

SIGNATURE


DATE

     






NASA FORM 1679 Nov 2012 PREVIOUS EDITION IS OBSOLETE. Page of


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