Registration Form

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

U.S. Office of Special Counsel

1730 M Street NW, Suite 218

Washington, DC 20036-4505

(202) 804-7163 certification@osc.gov

U.S. Office of Special Counsel’s

Certification Program Registration 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. If you have any questions about completing this form or

OSC’s Certification Program, please contact OSC’s Diversity, Outreach, and Training Unit at

certification@osc.gov or (202) 804-7163.

Please refer to our Certification Process Instructions.

General Information

Registering Agency or Office:

Agency and OIG ☐

Agency ☐

OIG ☐

Component (please indicate parent agency)

Contact Information

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):