Compliance Form (v2025)

• Issuer: U.S. Office of Special Counsel
• Section: U.S. Office of Special Counsel

Please provide the contact information for the official responsible for implementing OSC's

Certification Program (the individual’s name and phone number will be placed on OSC’s

website as the point of contact once the agency is certified).

Name:

Title:

Email:

Phone:

Address (to send certificate):

U.S. Office of Special Counsel

1730 M Street NW, Suite 218

Washington, DC 20036-4505

certification@osc.gov

U.S. Office of Special Counsel’s

Certification Program Compliance Form

The U.S. Office of Special Counsel’s (OSC) Certification Program allows federal agencies to

meet the statutory obligations of 5 U.S.C. § 2302(c), the Dr. Chris Kirkpatrick Whistleblower

Protection Act, and the Office of Special Counsel Reauthorization Act of 2017. In addition to

the existing requirements of the program, these statutes require agency heads to ensure that

their employees receive yearly information about whistleblower protection laws and to

provide annual supervisory training on how to respond to complaints involving whistleblower

protections. Using this form, please explain how the certifying agency has met the

requirements of OSC's Certification Program. The completed form should be emailed to

certification@osc.gov. Questions about completing this form should be directed to OSC’s

Outreach, Training & Compliance Unit, which can be reached at certification@osc.gov.

General Information

Agency or Office Certifying:

Agency and OIG ☐

Agency ☐

OIG ☐

Component (please indicate parent agency)

Contact Information