DA Form 4734-r "Invention Disclosure (Lra)"

DA Form 4734-R - also known as the "Invention Disclosure (lra)" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 4734-R - was last revised on October 1, 1978. Download an up-to-date fillable PDF version of the DA 4734-R below or request a copy through the chain of command.

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DEPARTMENT OF THE ARMY
PATENT
UNITED STATES OF AMERICA
ACTIVITIES
DOCKET NO
INVENTION DISCLOSURE
ASSIGNED TO:
(THIS FORM AND ACCOMPANYING DRAWING AND DESCRIPTION
SHEETS ARE TO BE COMPLETED FOR EACH INVENTION
PROMPTLY FORWARDED TO THE PATENT ACTIVITY*)
SHORT TITLE OF INVENTION
FULL NAME(S) OF INVENTOR(S)
(DUTY) TEL. NO. AREA CODE
HOME
ADDRESS(ES)
(FIRST)
(MIDDLE INITIAL)
(LAST)
(1)
(2)
(3)
(WHAT RECORDS SHOW THIS?)
ON WHAT DATE DID YOU FIRST THINK OF THIS INVENTION
INFORMATION
AND DATES
(4)
CONCERNING
GIVE DATE OF AND IDENTIFY EARLIEST SKETCH OR DRAWING
THIS INVENTION
(5)
NEEDED IN THE EVENT OF A
WHEN/WHERE AND TO WHOM DID YOU MAKE THE FIRST DISCLOSURE TO OTHERS OF THE INVENTION
CONTEST OF PRIORITY OF
EITHER ORALLY OR IN WRITING?
INVENTION IN THE U.S.
(6)
PATENT AND TRADEMARK
OFFICE, ALL RECORDS CITED
DESCRIBE DETAILS OF ANY WORK OR TESTS DONE TO PRODUCE OR OPERATE THE INVENTION
SHOULD BE DATED AND
GIVE DATES AND WITNESSES (USE OTHER PAGES IF NECESSARY)
SIGNED BY TWO
INDEPENDENT WITNESSES
(7)
WHO HAVE READ AND
DESCRIBE AND GIVE DATES OF ANY OTHER SKETCHES, DRAWINGS, OR REPORTS PERTINENT TO THIS
UNDERSTOOD THE
INVENTION
MATERIAL.
(8)
IF INVENTION HAS BEEN SOLD OR USED FOR PROFIT-WHEN AND TO WHOM DISCLOSED OR WHEN AND HOW
USE, SALE OR
USED?
PUBLICATION
(9)
NEEDED TO ESTABLISH THE
HAS A DESCRIPTION OF THIS INVENTION BEEN MADE AVAILABLE TO PERSONS OUTSIDE THE ARMY? (WRITTEN
DATE OF ANY PRINTED
PUBLICATION, PUBLIC USE
OR ORAL) IF SO, HOW AND WHEN AND WAS USE RESTRICTED?
OR SALE. SINCE NO PATENT
(10)
APPLICATION MAY BE FILLED
AFTER ONE YEAR FROM
SUCH DATE.
POTENTIAL MARKET
DESCRIBE ANY POTENTIAL, OR EXISTING MARKET FOR SALE OR LICENSE OF THIS INVENTION
(11)
INFORMATION
A . GOVERNMENT:
NEEDED FOR POSSIBLE
MARKETING
B. COMMERCIAL:
INVESTIGATIONS AND AS
AN AID TO POTENTIAL
LICENSING TO OTHERS.
C. IDENTIFY ANY KNOWN FIRMS OR VENDORS WHO MAY BE INTERESTED IN THE INVENTION:
IF THIS INVENTION WAS FIRST CONCEIVED OR CONSTRUCTED IN CONNECTION WITH:
CONTRACT
(12)
INFORMATION
A . MY DUTIES AS A GOVERNMENT EMPLOYEE
A DETERMINATION OF
B. MY WORK UNRELATED TO MY DUTIES AS A GOVERNMENT EMPLOYEE (PRIVATE, OFF DUTY ACTIVITIES)
RIGHTS IN THIS INVENTION
WILL BE NECESSARY. (SEE
C. MY DUTIES AS A GOVERNMENT EMPLOYEE & WORKING WITH A CONTRACTOR
AR 27-60)
D. NEITHER A, B , OR C, EXPLAIN
INDICATE THE POTENTIAL FOR USING THIS INVENTION IN FOREIGN COUNTRIES
FOREIGN FILING
(13)
CONSIDERATION
POOR
NEEDED TO DETERMINE THE
GOOD
POTENTIAL WORLDWIDE USE
FOR THE INVENTION.
EXCELLENT
PLEASE INDICATE THE SECURITY CLASSIFICATION IF KNOWN
SECURITY
(13A)
CLASSIFICATION
CLASSIFIED
LEVEL
UNCLASSIFIED
CLASSIFICATION UNKNOWN
DA FORM 4734-R, 1 OCT 1978
APD LC v1.00
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DEPARTMENT OF THE ARMY
PATENT
UNITED STATES OF AMERICA
ACTIVITIES
DOCKET NO
INVENTION DISCLOSURE
ASSIGNED TO:
(THIS FORM AND ACCOMPANYING DRAWING AND DESCRIPTION
SHEETS ARE TO BE COMPLETED FOR EACH INVENTION
PROMPTLY FORWARDED TO THE PATENT ACTIVITY*)
SHORT TITLE OF INVENTION
FULL NAME(S) OF INVENTOR(S)
(DUTY) TEL. NO. AREA CODE
HOME
ADDRESS(ES)
(FIRST)
(MIDDLE INITIAL)
(LAST)
(1)
(2)
(3)
(WHAT RECORDS SHOW THIS?)
ON WHAT DATE DID YOU FIRST THINK OF THIS INVENTION
INFORMATION
AND DATES
(4)
CONCERNING
GIVE DATE OF AND IDENTIFY EARLIEST SKETCH OR DRAWING
THIS INVENTION
(5)
NEEDED IN THE EVENT OF A
WHEN/WHERE AND TO WHOM DID YOU MAKE THE FIRST DISCLOSURE TO OTHERS OF THE INVENTION
CONTEST OF PRIORITY OF
EITHER ORALLY OR IN WRITING?
INVENTION IN THE U.S.
(6)
PATENT AND TRADEMARK
OFFICE, ALL RECORDS CITED
DESCRIBE DETAILS OF ANY WORK OR TESTS DONE TO PRODUCE OR OPERATE THE INVENTION
SHOULD BE DATED AND
GIVE DATES AND WITNESSES (USE OTHER PAGES IF NECESSARY)
SIGNED BY TWO
INDEPENDENT WITNESSES
(7)
WHO HAVE READ AND
DESCRIBE AND GIVE DATES OF ANY OTHER SKETCHES, DRAWINGS, OR REPORTS PERTINENT TO THIS
UNDERSTOOD THE
INVENTION
MATERIAL.
(8)
IF INVENTION HAS BEEN SOLD OR USED FOR PROFIT-WHEN AND TO WHOM DISCLOSED OR WHEN AND HOW
USE, SALE OR
USED?
PUBLICATION
(9)
NEEDED TO ESTABLISH THE
HAS A DESCRIPTION OF THIS INVENTION BEEN MADE AVAILABLE TO PERSONS OUTSIDE THE ARMY? (WRITTEN
DATE OF ANY PRINTED
PUBLICATION, PUBLIC USE
OR ORAL) IF SO, HOW AND WHEN AND WAS USE RESTRICTED?
OR SALE. SINCE NO PATENT
(10)
APPLICATION MAY BE FILLED
AFTER ONE YEAR FROM
SUCH DATE.
POTENTIAL MARKET
DESCRIBE ANY POTENTIAL, OR EXISTING MARKET FOR SALE OR LICENSE OF THIS INVENTION
(11)
INFORMATION
A . GOVERNMENT:
NEEDED FOR POSSIBLE
MARKETING
B. COMMERCIAL:
INVESTIGATIONS AND AS
AN AID TO POTENTIAL
LICENSING TO OTHERS.
C. IDENTIFY ANY KNOWN FIRMS OR VENDORS WHO MAY BE INTERESTED IN THE INVENTION:
IF THIS INVENTION WAS FIRST CONCEIVED OR CONSTRUCTED IN CONNECTION WITH:
CONTRACT
(12)
INFORMATION
A . MY DUTIES AS A GOVERNMENT EMPLOYEE
A DETERMINATION OF
B. MY WORK UNRELATED TO MY DUTIES AS A GOVERNMENT EMPLOYEE (PRIVATE, OFF DUTY ACTIVITIES)
RIGHTS IN THIS INVENTION
WILL BE NECESSARY. (SEE
C. MY DUTIES AS A GOVERNMENT EMPLOYEE & WORKING WITH A CONTRACTOR
AR 27-60)
D. NEITHER A, B , OR C, EXPLAIN
INDICATE THE POTENTIAL FOR USING THIS INVENTION IN FOREIGN COUNTRIES
FOREIGN FILING
(13)
CONSIDERATION
POOR
NEEDED TO DETERMINE THE
GOOD
POTENTIAL WORLDWIDE USE
FOR THE INVENTION.
EXCELLENT
PLEASE INDICATE THE SECURITY CLASSIFICATION IF KNOWN
SECURITY
(13A)
CLASSIFICATION
CLASSIFIED
LEVEL
UNCLASSIFIED
CLASSIFICATION UNKNOWN
DA FORM 4734-R, 1 OCT 1978
APD LC v1.00
PAGE
OF
PAGES
DEPARTMENT OF THE ARMY
UNITED STATES OF AMERICA
PATENT
INVENTION DISCLOSURE
ACTIVITIES
DOCKET NO
(DRAWING AND DESCRIPTION SHEET)
(14) PROVIDE THE FOLLOWING INFORMATION CONCERNING THE DISCLOSED INVENTION AND IN THE INDICATED SEQUENCE:
A . SPECIFICALLY DESCRIBE THE INVENTION AND ITS OPERATION. YOU MAY USE AND ATTACH COPIES OF SKETCHES, PRINTS, PHOTOGRAPHS, PAPERS
AND ILLUSTRATIONS, WHICH SHOULD BE SIGNED, WITNESSED, AND DATED. USE NUMBERS AND DESCRIPTIVE NAMES IN DESCRIPTIONS AND DRAWINGS.
B. STATE THE ADVANTAGES OF THE INVENTION OVER PRESENTLY KNOWN DEVICES, SYSTEMS, OR PROCESSES.
C. DISCUSS THE PROBLEMS WHICH THE INVENTION IS DESIGNED TO SOLVE, REFERRING TO ANY PRIOR INVENTION OF A SIMILAR NATURE WITH WHICH
YOU MAY BE FAMILIAR.
D. LIST ALL KNOWN AND OTHER POSSIBLE USES FOR THE INVENTION.
E. LIST THE FEATURES OF THE INVENTION THAT ARE BELIEVED TO BE NOVEL.
USE AS MANY OF THESE SHEETS AS NECESSARY AND ATTACH TO COMPLETED INVENTION DISCLOSURE
THE DESCRIBED INVENTION HAS BEEN
WITNESSED READ AND UNDERSTOOD BY:
SIGNATURE(S) AND ORGANIZATION OF INVENTOR(S) (USE INK)
DATE:
DATE:
(18)
(15)
ORGANIZATION
(16)
(19)
ORGANIZATION
(17)
(20)
ORGANIZATION
*NOTE: THIS FORM AND ANY OMITTED INFORMATION BECOMING AVAILABLE AT A LATER TIME SHOULD BE FORWARD TO:
HQDA CHIEF, INTELLECTUAL, PROPERTY DIV.
DARCOM
ATTN: PATENT COUNSEL; OR CHIEF OF ENGINEERS
ATTN: PATENT COUNSEL
OFFICE OF THE JUDGE ADVOCATE GENERAL
DEPT. OF THE ARMY
WASHINGTON, D.C., 20310
REVERSE OF DA FORM 4734-R, 1 OCT 1978
APD LC v1.00
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