SW - Office of the Vice President for Research



For office use onlyDate stamp hereUTA # _________________(S)Email to: disclosure@otc.utexas.edu Send signed original to: WPR Building, Suite 1.9A (R3500)Intellectual Property Questionnaire (IPQ) for SoftwareThe attached form has been designed as a download; please feel free to expand the spaces provided so that you may answer questions completely and to duplicate blocks for adding additional contributors, research sponsors, and publications.Please include with this submission:A copy of any accompanying material, such as a user guideAny published articles, poster presentations, or other materials you have available that describe the functionality of the softwareIf you believe that the software may also embody patentable inventions, please complete and submit a separate invention disclosure, available online at the OTC website under “Forms for Inventors” ().Official processing of this invention disclosure cannot begin until it is fully completed, signed by all UT inventors and the principal investigator for the research (whether or not the principal investigator is an inventor), and submitted to the Office of Technology Commercialization.1.Title suggested by inventors: 2.Please list the principal investigator or unit director for the research that led to the creation of the software.Name EID Department Position Work address Work phone Email Fax Home address Home phone Country of citizenship Other appt Administrative contact for furnishing additional information if required:Name Position Email Work phone Did the principal investigator/unit director contribute to the creation of the software? (check one) [??]Yes????[??]No Principal investigator’s/unit director’s signature 3.Please list all those who contributed to the creation of the software. (Copy this block to list additional contributors.)Name EID Department Position Work address Work phone Email Fax Home address Home phone Country of citizenship* Other appt Contributor's signature Name EID Department Position Work address Work phone Email Fax Home address Home phone Country of citizenship* Other appt Contributor's signature Name EID Department Position Work address Work phone Email Fax Home address Home phone Country of citizenship* Other appt Contributor's signature 4.Were all inventors acting in their capacity as employees of The University of Texas at Austin during the development of this software?(check one) [??]Yes????[??]NoIf No, please identify and explain: 5.Please provide a detailed summary of the software, its use and purpose. To comply with the Bayh-Dole regulations for government sponsored inventions, the federal government requires that we provide sufficient technical detail to convey a clear understanding of the nature, purpose, operation, and the physical, chemical, biological or electrical characteristics of the invention.6.What problem(s) does the software solve? 7.Please identify other available software that performs similar functions. 8.How is the software different from other available software? What advantages over current software does it possess? 9.Technical details:a. Describe the hardware configurations(s) required to operate the software: b. Identify the operating system(s) required: c. List any utilities required. d. What programming language(s) wer used to create the software? 10.Is the software a component or function of a greater body of code? (check one) [??]Yes????[??]NoIf yes, what is the purpose of that component or function? 11.Does the software include any open source or free software other than software created by the contributors identified above while they worked at UT? (check one) [??]Yes????[??]NoIf Yes, please identify:Name of software License under which it was used (include a copy with this submission) Name of software License under which it was used (include a copy with this submission) Name of software License under which it was used (include a copy with this submission) 12.Is software that is owned and/or authored by persons or entities other than those listed in Questions 2 and 3 incorporated into the software? (check one) [??]Yes????[??]NoIf Yes, please list all third-party sources: 13.Is the software a derivative work? (check one) [??]Yes????[??]NoIf Yes, name the work from which it was derived: Has the author of this work given authorization to create derivative works? (check one) [??]Yes????[??]NoIf Yes, please attach the documentation giving authorization or state the source of the authorization. 14.What companies do you believe would be interested in licensing or distributing the software?15.Have you been approached by any companies regarding the software? (check one) [??]Yes????[??]NoIf Yes, which companies? (List contact names if available.) 16.Estimate the level of customization and/or support the software will need once licensed. 17.Do you intend to publicly release the software under an open source license?(check one) [??]Yes????[??]NoIf Yes, please explain reasoning and form of license that you’re considering using. 18.OTC will not review this Software Disclosure for potential patentability. If you believe that the software may contain commercially valuable, patentable subject matter, a separate invention disclosure (physical sciences) form must be submitted. Have you submitted a separate invention disclosure (physical sciences) form, or do you plan to submit one, to OTC for patentable inventions included in the software? (check one) [??]Yes????[??]No19.Provide the dates (month and year) that development of the software began and that development was completed. (Indicate if approximate.)Date begun: Date completed: 20.Was the development of this software supported by a grant or contract? (check one) [??]Yes????[??]NoIf Yes, please list below. If No, please explain why you believe this research result is outside any existing sponsored research: Note: Types of sponsors include but are not limited to, NIH, other federal agencies, state agencies, non-profit research foundations, and private companies. Gift contributions need not be listed. (Copy this block to list additional sponsors.)Name of sponsor: Title of project: UT Austin acct #: Grant #: Has agency/sponsor imposed restrictions on the dissemination of information about this project? (check one) [??]Yes????[??]NoDoes the agency/sponsor require approval prior to publication? (check one) [??]Yes????[??]NoName of sponsor: Title of project: UT Austin acct #: Grant #: Has agency/sponsor imposed restrictions on the dissemination of information about this project? (check one) [??]Yes????[??]NoDoes the agency/sponsor require approval prior to publication? (check one) [??]Yes????[??]NoName of sponsor: Title of project: UT Austin acct #: Grant #: Has agency/sponsor imposed restrictions on the dissemination of information about this project? (check one) [??]Yes????[??]NoDoes the agency/sponsor require approval prior to publication? (check one) [??]Yes????[??]No21.Do you have any other current sponsored research agreements in place? (check one) [??]Yes????[??]NoIf Yes, please list below. If No, please explain why you believe this research result is outside any existing sponsored research: Note: Types of sponsors include but are not limited to, NIH, other federal agencies, state agencies, non-profit research foundations, and private companies. Gift contributions need not be listed. (Copy this block to list additional sponsors.)Name of sponsor: Title of project: UT Austin acct #: Grant #: Has agency/sponsor imposed restrictions on the dissemination of information about this project? (check one) [??]Yes????[??]NoDoes the agency/sponsor require approval prior to publication? (check one) [??]Yes????[??]NoName of sponsor: Title of project: UT Austin acct #: Grant #: Has agency/sponsor imposed restrictions on the dissemination of information about this project? (check one) [??]Yes????[??]NoDoes the agency/sponsor require approval prior to publication? (check one) [??]Yes????[??]No22.Does your software perform “cryptography,” or otherwise contain any parts or components that are capable of performing any of the following “information security” functions (e.g., to protect data during storage or communication)? [??]Yes????[??]No Encryption[??]Yes????[??]No Decryption only (no encryption)[??]Yes????[??]No Key management/public key infrastructure (PKI)[??]Yes????[??]No Authentication (e.g., password protection, digital signatures)[??]Yes????[??]No Copy protection[??]Yes????[??]No Anti-virus protection[??]Yes????[??]No Obfuscation[??]Yes????[??]No Hashing[??]Yes????[??]No Other security functionsNote: Please answer the question without regard to whether the encryption/information security function is provided by proprietary code, third-party code, or “publicly available” third-party software.23.If your software does not contain or use encryption/information security code, does it “call to,” contain “hooks” for or otherwise make use of existing cryptographic/information security functionality that is already present in another product such as a processor, other hardware, an operating system, another application, or a cryptographic library?(check one) [??]Yes????[??]No24.If the answer is Yes to either or both of the above two questions, please provide:Type(s) of encryption/security (e.g., SSL, SHA, RSA, obfuscation, hashing) Relevant key length(s) (e.g., 56-bit, 64-bit, 128-bit, etc.) Purpose(s) (e.g., copyright protection, protect data during communications, protectpasswords, digital signature, etc.) Type(s) of encryption/security (e.g., SSL, SHA, RSA, obfuscation, hashing) Relevant key length(s) (e.g., 56-bit, 64-bit, 128-bit, etc.) Purpose(s) (e.g., copyright protection, protect data during communications, protectpasswords, digital signature, etc.) 25.Non-Proprietary Description – This one-page form will be used to market your software through OTC's web site and for mailing preliminary information to interested parties, including the media. The text should be understandable by anyone who is semi-skilled in your technology area. Examples can be found at: # _________________(S)Office UseNon-Proprietary DescriptionPlease send an electronic version of this Non-Proprietary Description to disclosure@otc.utexas.edu.Title: Background:(Why is there a need for such a tool? What are the drawbacks of other, similar tools if available?) Invention Description:(A non-proprietary description of the software) Features:(The characteristics of the software: coded in assembly/binds selectively to XYZ receptor/etc.) Benefits:(The results of the features. Why do I care? 2X faster operation/fewer side effects/cheap to produce/etc.) Markets:(Who might be interested in your software? Quantify if possible; cite sources) Development Stage:(Choose one: Idea / Proof of concept / Alpha software / Beta software / Commercial software) ................
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