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<tbody>
<tr class="odd">
<td colspan="2" rowspan="2"><img src="media/image1.png" /></td>
<td rowspan="2"><strong>National Aeronautics and Space
Administration</strong></td>
<td colspan="6" rowspan="2"><blockquote>
<p><strong>Disclosure of Invention and New Technology (Including
Software)</strong></p>
</blockquote></td>
<td colspan="4"><p><strong>Form Approved</strong></p>
<p><strong>O.M.B. NO.</strong></p>
<p><strong>2700-0009</strong></p></td>
<td colspan="2"><h2 id="date">DATE</h2>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="6"><p>CONTRACTOR CASE NO.</p>
<p>     </p></td>
</tr>
<tr class="odd">
<td colspan="10"><blockquote>
<p>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</p>
</blockquote></td>
<td colspan="5"><p>NASA CASE NO. (OFFICIAL USE ONLY)</p>
<p>     </p></td>
</tr>
<tr class="even">
<td colspan="15"><blockquote>
<p>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.</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="15"><ol type="1">
<li><p>DESCRIPTIVE TITLE</p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="2" type="1">
<li><p>INNOVATOR(S) <em>(For each innovator provide: Name, Title, Phone
Number, E-mail Address, and Home Address. For non U.S. citizens, include
INS Form I-551 No. and expiration date. If multiple innovators, number
each to match Box 5.)</em></p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="15"><ol start="3" type="1">
<li><p>INNOVATOR’S EMPLOYER WHEN INNOVATION MADE <em>(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.)</em></p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="4" type="1">
<li><p>PLACE OF PERFORMANCE <em>(Address(es) where innovation
made)</em></p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="3" rowspan="2"><ol start="5" type="1">
<li><p>EMPLOYER STATUS <em>(choose one for each innovator)</em></p></li>
</ol>
<p><strong>     </strong> <strong>     </strong></p>
<p>Innovator #1 Innovator #3</p>
<p><strong>     </strong> <strong>     </strong></p>
<p>Innovator #2 Innovator #4</p>
<p>GE = Government</p>
<p>CU = College or University</p>
<p>NP = Non-Profit Organization</p>
<p>SB = Small Business Firm</p>
<p>LE = Large Entity</p></td>
<td colspan="12"><ol start="6" type="1">
<li><p>ORIGIN <em>(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.)</em></p></li>
</ol></td>
</tr>
<tr class="even">
<td colspan="9"><p> NASA In-house Org. Mail Code
<strong>     </strong></p>
<p> Grant/Cooperative Agreement No. <strong>     </strong></p>
<p> Prime Contract No. <strong>     </strong></p>
<p>Task No. <strong>     </strong> Report No. <strong>     </strong></p>
<p> Subcontractor; Subcontract Tier <strong>     </strong></p>
<p> Joint Effort (<em>contractor, subcontractor and/or grantee
contribution(s), and NASA in-house contribution</em>)</p>
<p> Multiple Effort (<em>multiple contractor, subcontractor and/or
grantee contributions, no NASA in-house contribution</em>)</p>
<p> Other (<em>e.g., Space Act Agreement, MOA</em>) No.      </p></td>
<td colspan="3"><p>UPN <strong>     </strong></p>
<p>UPN <strong>     </strong></p>
<p>UPN <strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="7"><ol start="7" type="1">
<li><p>NASA CONTRACTING OFFICER’S TECHNICAL REPRESENTATIVE
<em>(COTR)</em></p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
<td colspan="8"><ol start="8" type="1">
<li><p>CONTRACTOR/GRANTEE NEW TECHNOLOGY REPRESENTATIVE
<em>(POC)</em></p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="9" type="1">
<li><p>BRIEF ABSTRACT <em>(A general description of the innovation which
describes its capabilities, but does not reveal details that would
enable duplication or imitation of the innovation.)</em></p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="15"><strong>NASA FORM 1679</strong> JUL 2000 PREVIOUS
EDITION IS OBSOLETE. <strong>Page 1 of 4</strong></td>
</tr>
<tr class="even">
<td colspan="15"><p><strong>SECTION I – DESCRIPTION OF THE PROBLEM OR
OBJECTIVE THAT MOTIVATED THE INNOVATION’S DEVELOPMENT <em>(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.)</em></strong></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong>SECTION II – TECHNICALLY COMPLETE AND EASILY
UNDERSTANDABLE DESCRIPTION OF INNOVATION DEVELOPED TO SOLVE THE PROBLEM
OR MEET THE OBJECTIVE <em>(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;</em></strong></p>
<p><em><strong>G. – Peripheral equipment; and H. – Maintenance,
reliability, safety factors.)</strong></em></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="15"><strong>NASA FORM 1679</strong> JUL 2000 PREVIOUS
EDITION IS OBSOLETE. <strong>Page 2 of 4</strong></td>
</tr>
<tr class="odd">
<td colspan="15"><p><strong>SECTION III – UNIQUE OR NOVEL FEATURES OF
THE INNOVATION AND THE RESULTS OR BENEFITS OF ITS APPLICATION <em>(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.)</em></strong></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="15"><p><strong>SECTION IV – SPECULATION REGARDING POTENTIAL
COMMERCIAL APPLICATIONS AND POINTS OF CONTACT</strong>
<em><strong>(Including names of companies producing or using similar
products.)</strong></em></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="15"><strong>NASA FORM 1679</strong> JUL 2000 PREVIOUS
EDITION IS OBSOLETE. <strong>Page 3 of 4</strong></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="10" type="1">
<li><p>ADDITIONAL DOCUMENTATION <em>(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.).)</em></p></li>
</ol>
<blockquote>
<p>TITLE PAGE DATE</p>
<p>                 </p>
<p>                 </p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="15"><ol start="11" type="1">
<li><p>DEGREE OF TECHNOLOGY SIGNIFICANCE <em>(Which best expresses the
degree of technological significance of this innovation?)</em></p></li>
</ol>
<p> Modification to Existing Technology Substantial Advancement in the
Art Major Breakthrough</p></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="12" type="1">
<li><p>STATE OF DEVELOPMENT</p></li>
</ol>
<p> Concept Only Design Prototype Modification Production Model Used in
Current Work</p></td>
</tr>
<tr class="odd">
<td colspan="15"><ol start="13" type="1">
<li><p>PATENT STATUS (Prior patent on/or related to this
innovation.)</p></li>
</ol>
<p> Application Filed Application No.       Application Date      </p>
<p> Patent Issued Patent No.       Issue Date      </p></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="14" type="1">
<li><p>INDICATE THE DATE OR THE APPROXIMATE TIME PERIOD WHICH THIS
INNOVATION WAS DEVELOPED <em>(i.e., conceived, constructed, tested,
etc.)</em></p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="15"><ol start="15" type="1">
<li><p>PREVIOUS OR CONTEMPLATED PUBLICATION OR PUBLIC DISCLOSURE
INCLUDING DATES <em>(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.)</em></p></li>
</ol>
<blockquote>
<p><strong>     </strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="16" type="1">
<li><p>QUESTIONS FOR SOFTWARE ONLY</p></li>
</ol></td>
</tr>
<tr class="odd">
<td colspan="15"><p>(a) Using non-NASA employees to beta-test the
program? YES NO If Yes, done under a beta-test agreement? YES NO</p>
<p>(b) Modification of this program continue by civil servant and/or
contractual agreement? YES NO</p>
<p>(c) Copyright registered? YES NO UNKNOWN If Yes, then by whom?
<strong>     </strong></p>
<p>(d) Has the latest version been distributed outside of NASA or
contractor? YES NO UNKNOWN</p>
<p>If Yes, date of first disclosure: <strong>     </strong></p>
<p>(e) Were prior versions distributed outside of NASA or Contractor?
YES NO If Yes, supply NASA or contractor contract:      </p>
<p>(f) Contains or based on code not owned by U.S. Government or its
contractors? YES NO UNKNOWN</p>
<p>If Yes, name of code and code’s owner:      </p>
<p>Has a license for use been obtained? YES NO UNKNOWN</p></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="17" type="1">
<li><p>DEVELOPMENT HISTORY</p></li>
</ol></td>
</tr>
<tr class="odd">
<td colspan="4">STAGE OF DEVELOPMENT</td>
<td colspan="2"><p>DATE</p>
<p>(MM/YYYY)</p></td>
<td colspan="5">LOCATION</td>
<td colspan="4">IDENTIFY SUPPORTING WITNESSES (NASA in-house only)</td>
</tr>
<tr class="even">
<td colspan="4"><ol type="a">
<li><p>First disclosure to others</p></li>
</ol></td>
<td colspan="2">     </td>
<td colspan="5">     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td colspan="4"><ol start="2" type="a">
<li><p>First sketch, drawing, logic chart or code</p></li>
</ol></td>
<td colspan="2">     </td>
<td colspan="5">     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td colspan="4"><ol start="3" type="a">
<li><p>First written description</p></li>
</ol></td>
<td colspan="2">     </td>
<td colspan="5">     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td colspan="4"><ol start="4" type="a">
<li><p>Completion of first model of full size device
<em>(invention)</em> or beta version <em>(software)</em></p></li>
</ol></td>
<td colspan="2">     </td>
<td colspan="5">     </td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td colspan="4"><ol start="5" type="a">
<li><p>First successful operational test <em>(invention)</em> or alpha
version <em>(software)</em></p></li>
</ol></td>
<td colspan="2">     </td>
<td colspan="5">     </td>
<td colspan="4">     </td>
</tr>
<tr class="odd">
<td colspan="15"><ol start="6" type="a">
<li><p>Contribution of innovators <em>(if jointly developed, provide the
contribution of each innovator)</em></p></li>
</ol>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="15"><ol start="7" type="a">
<li><p>Indicate any past, present, or contemplated government use of the
innovation</p></li>
</ol>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="15"><ol start="18" type="1">
<li><p>SIGNATURES OF INNOVATOR(S), WITNESS(ES), AND NASA
APPROVAL</p></li>
</ol></td>
</tr>
<tr class="even">
<td colspan="5"><p>TYPED NAME AND SIGNATURE <em>(Innovator #1)</em></p>
<p><strong>     </strong></p></td>
<td colspan="3"><p>DATE</p>
<p><strong>     </strong></p></td>
<td colspan="6"><p>TYPED NAME AND SIGNATURE <em>(Innovator #2)</em></p>
<p><strong>     </strong></p></td>
<td><p>DATE</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td colspan="5"><p>TYPED NAME AND SIGNATURE <em>(Innovator #3)</em></p>
<p><strong>     </strong></p></td>
<td colspan="3"><p>DATE</p>
<p><strong>     </strong></p></td>
<td colspan="6"><p>TYPED NAME AND SIGNATURE <em>(Innovator #4)</em></p>
<p><strong>     </strong></p></td>
<td><p>DATE</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="5"><p>TYPED NAME AND SIGNATURE <em>(Witness #1)</em></p>
<p><strong>     </strong></p></td>
<td colspan="3"><p>DATE</p>
<p><strong>     </strong></p></td>
<td colspan="6"><p>TYPED NAME AND SIGNATURE <em>(Witness #2)</em></p>
<p><strong>     </strong></p></td>
<td><p>DATE</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="odd">
<td>NASA<br />
APPROVED</td>
<td colspan="7">TYPED<br />
NAME <strong>     </strong></td>
<td colspan="6">SIGNATURE</td>
<td><p>DATE</p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td colspan="15"><strong>NASA FORM 1679</strong> JUL 2000 PREVIOUS
EDITION IS OBSOLETE. <strong>Page 4 of 4</strong></td>
</tr>
</tbody>
</table>