Registration Form (v2024)

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

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U.S. Office of SpecialCounsel

1730 M StreetNW,Suite218

Washington,DC20036-4505

certification@osc.gov

U.S. Office of Special Counsel’s

Certification ProgramRegistration 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 ReauthorizationAct of 2017. In addition to the existingrequirementsofthe

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.

Pleaserefertoour CertificationProcessInstructions.

Registering Agency or Office:

AgencyandOIG

Agency

OIG

Component (please indicate parent agency)

Please provide the contactinformationfor the official responsible forimplementingOSC'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):

GeneralInformation

ContactInformation