Official Federal Forms > US Copyright Office
Short Form VA VA - Official Federal Forms
| Short Form VA Form. This is a national form and can be used in US Copyright Office . |
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4 Instructions for Short Form VA For pictorial, graphic, and sculptural works HOW TO COMPLETE SHORT FORM VA · Typeorprintinblackink. · Beclearandlegible. · Giveonlytheinformationrequested. Note:Youmayuseacontinuationsheet(Form__/CON)tolistindividualtitlesinacollection.CompletespaceAandlisttheindividual titlesunderspaceConthebackpage.SpaceBisnotapplicabletoshort forms. USE THIS FORM IF-- 1. Youaretheonly authorandcopyrightownerofthiswork,and 2. Theworkwasnot madeforhire,and 3. Theworkiscompletelynew(doesnotcontainasubstantialamount ofmaterialthathasbeenpreviouslypublishedorregisteredorisin thepublicdomain). If any of the above does not apply, you may register online at www.copyright.gov or use Form VA. NOTE: Short Form VA is not appropriate for an anonymous author who does not wish to reveal his or her identity. Youmustgiveatitle.Ifthereisnotitle,state"UNTITLED."Ifyou are registering an unpublished collection, give the collection title youwanttoappearinourrecords(forexample:"JewelrybyJosephine,1995 Volume").Alternativetitle:Iftheworkisknownbytwotitles,youalsomay givethesecondtitle.Iftheworkhasbeenpublishedaspartofalargerwork (includingaperiodical),givethetitleofthatlargerworkinsteadofanalternativetitle,inadditiontothetitleofthecontribution. 1 Title of This Work Checktheboxorboxesthatdescribeyourauthorshipinthematerial youaresending.Forexample,ifyouareregisteringillustrationsbut havenotwrittenthestoryyet,checkonlytheboxfor"2-dimensionalartwork." 5 6 7 8 9 Type of Authorship in This Work Signature of Author 2 3 4 Name and Address of Author and Owner of the Copyright Sign the application in black ink and check the appropriate box. Thepersonsigningtheapplicationshouldbetheauthororhis/her authorizedagent. Giveyournameandmailingaddress.Youmayincludeyourpseudonymfollowedby"pseud."Also,givethenationofwhichyouareacitizenor whereyouhaveyourdomicile(i.e.,permanentresidence). Givedaytimephoneandfaxnumbersandemailaddress,ifavailable. Person to Contact for Rights/Permissions Thisspaceisoptional.Youmaygivethenameandaddressofthe personororganizationtocontactforpermissiontousethework. Youmayalsoprovidephone,fax,oremailinformation. Year of Creation Givethelatestyearinwhichyoucompletedtheworkyouareregisteringatthistime.Aworkis"created"whenitis"fixed"inatangible form.Examples:drawnonpaper,moldedinclay,storedinacomputer. Certificate Will Be Mailed Thisspacemustbecompleted.Yourcertificateofregistrationwillbe mailedinawindowenvelopetothisaddress.Also,iftheCopyright Officeneedstocontactyou,wewillwritetothisaddress. Publication Iftheworkhasbeenpublished(i.e.,ifcopieshavebeendistributed tothepublic),givethecompletedateofpublication(month,day, andyear)andthenationwherethepublicationfirsttookplace. Deposit Account Completethisspaceonlyifyoucurrentlymaintainadepositaccount intheCopyrightOffice. MAIL WITH THE FORM · Thefilingfeeintheformofacheckormoneyorder(no cash)payableto Register of Copyrights.(CopyrightOfficefeesaresubjecttochange.For currentfees,checktheCopyrightOfficewebsiteatwww.copyright.gov, writetheCopyrightOffice,orcall(202)707-3000or1-877-476-0778 (tollfree)). · Oneortwocopiesoftheworkoridentifyingmaterialconsistingof photographsordrawingsshowingthework.Seetable(right)forrequirementsformostworks.Note:ReadCircular40afortherequirementsforotherworks.Copiessubmittedbecomethepropertyofthe U.S.government. Maileverything(applicationform,copyorcopies,andfee)in one packageto: Library of Congress Copyright Office-VA 101 Independence Avenue SE Washington, DC 20559 Questions?Call(202)707-3000or1-877-476-0778(tollfree).Recordedinformationisavailable24hoursaday.Orderformsandotherpublications fromLibrary of Congress, Copyright Office-COPUBS, 101 Independence Avenue, SE, Washington, DC20559,orcall(202)707-9100.Downloadcircularsand otherinformationorregisteronlineat www.copyright.gov. If you are registering: · 2-dimensionalartwork inabook,map,poster, orprint · 3-dimensionalsculpture · 2-dimensionalartwork appliedtoaT-shirt · agreetingcard,pattern, commercialprintorlabel, fabric,orwallpaper And the work is unpublished/published, send: a. Andtheworkisunpublished,send onecompletecopyoridentifyingmaterial b. Andtheworkispublished,send twocopiesofthebestpublishededition a. Andtheworkisunpublished,send identifyingmaterial b. Andtheworkispublished,send identifyingmaterial a. Andtheworkisunpublished,send onecompletecopyoridentifyingmaterial b. Andtheworkispublished,send onecopyofthebestpublishededition PRIVACY ACT ADVISORY STATEMENT Required by the Privacy Act of 1974 (P.L. 93-579) The authority for requesting this information is title 17 U.S.C. §409 and §410. Furnishing the requested information is voluntary. But if the information is not furnished, it may be necessary to delay or refuse registration and you may not be entitled to certain relief, remedies, and benefits provided in chapters 4 and 5 of title 17 U.S.C. The principal uses of the requested information are the establishment and maintenance of a public record and the examination of the application for compliance with the registration requirements of the copyright law. Other routine uses include public inspection and copying, preparation of public indexes, preparation of public catalogs of copyright registrations, and preparation of search reports upon request. NOTE: No other advisory statement will be given in connection with this application. Please keep this statement and refer to it if we communicate with you regarding this application. American LegalNet, Inc. www.FormsWorkFlow.com Copyright Office fees are subject to change. For current fees, check the Copyright Office website at www.copyright.gov, write the Copyright Office, or call (202) 707-3000 or 1-877-476-0778. Privacy Act Notice: Sections 408-410 of title 17 of the United States Code authorize the Copyright Office to collect the personally identifying information requested on this form in order to process the application for copyright registration. By providing this information, you are agreeing to routine uses of the information that include publication to give legal notice of your copyright claim as required by 17 U.S.C. §705. It will appear in the Office's online catalog. If you do not provide the information requested, registration may be refused or delayed, and you may not be entitled to certain relief, remedies, and benefits under the copyright law. Examined By 3 Short Form VA For a Work of the Visual Arts UNITEDSTATESCOPYRIGHTOFFICE REGISTRATIONNUMBER Effective Date of Registration VA VAU A
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