Registration Form (v2025)

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

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U.S. Officeof Special Counsel

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 Reauthorization Act of 2017. Inadditionto the existing

requirementsof 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

Outreach, Training & Compliance 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