OMB No. 3124-0009 

MERIT SYSTEMS PROTECTION BOARD 

APPEAL FORM (MSPB FORM 185) 

INSTRUCTIONS FOR COMPLETING YOUR APPEAL 

GENERAL: This form is intended to help you provide the 

Board with the information we need to process your appeal. 

We need this information to help us determine whether the 

Board has jurisdiction over your appeal, whether it has been 

filed within the applicable time limit, and what claims you are 

raising. You do not have to use this form to file an appeal with 

the Board. However, if you do not, your appeal must still 

comply with the Board's regulations. See 5 C.F.R. Parts 

1201, 1208 and 1209. The Board will expect you to become 

familiar with these regulations, which are available on the 

MSPB website— www.mspb.gov—and in MSPB offices, 

many agency personnel offices and libraries, and most public 

libraries. The Board's website also contains electronic 

versions of this form, addresses and telephone numbers of 

the MSPB regional and field offices, and additional 

information that explains the Board’s practices and 

procedures. Note, however, that if you complete one of the 

electronic versions of the appeal form at our website 

(https://e-appeal.mspb.gov/), you may not submit it via e-mail. 

If you want to file an appeal on-line, you must use the Board’s 

e-Appeal site listed at the bottom of this page. 

WHAT PARTS TO COMPLETE: You may use this form for 

any of the following matters over which the Board has 

jurisdiction: 

 An appeal of a Federal agency personnel action or 

decision that is appealable to the Board under a law, 

rule, or regulation; 

 An appeal of an administrative decision or action by 

the Office of Personnel Management (OPM) or a 

Federal agency affecting your retirement rights or 

benefits; 

 An Individual Right of Action (IRA) appeal under the 

Whistleblower Protection Act (WPA); 

 An appeal under the Uniformed Services Employment 

and Reemployment Rights Act (USERRA); or 

 An appeal under the redress procedure of the 

Veterans Employment Opportunities Act (VEOA). 

Complete Part 1 of this form regardless of which type of 

appeal you are filing. Your appeal must contain your 

signature, or the signature of your representative, in 

question 12 of Part 1. If it does not, your appeal will be 

rejected and returned to you. 

Complete Part 2 if you are appealing a Federal agency 

personnel action or decision, other than an action or decision 

affecting your retirement rights or benefits. See 5 C.F.R. 

1201.24(a). 

Complete Part 3 if you are appealing an administrative 

decision or action affecting your retirement rights or benefits. 

See 5 C.F.R. 1201.24(a). 

Part 4 lists certain other claims you may raise in addition to 

an appeal of an agency personnel or retirement action or 

decision. If you wish to raise any of these claims at this time, 

check the appropriate box (or boxes) in Part 4 and provide 

supporting information as an attachment to this form. You 

may raise such claims and provide the information later—but 

no later than the close of the conference(s) held to define the 

issues in your appeal. See 5 C.F.R. 1201.24(b). 

Complete Part 5 ONLY if you are filing one of the following 

types of appeals: 

 An IRA appeal under the WPA. See 5 C.F.R. 1209.6; 

 A USERRA appeal. See 5 C.F.R. 1208.13; or 

 A VEOA appeal. See 5 C.F.R. 1208.23. 

See Part 5 for an explanation of these three types of appeals. 

If you complete Part 5, you must provide the additional 

information required by the Board’s regulations for the 

particular type of appeal as an attachment to this form. The 

Board may consider ONLY the claim that the agency violated 

the particular law involved and may NOT consider the merits 

of the underlying action or decision. 

If you wish to designate someone to represent you in this 

appeal, also complete and sign Part 6, Designation of 

Representative. See 5 C.F.R. 1201.31. 

If you prefer to file your appeal electronically, please visit 

 MSPB e-Appeal Online—https://e-appeal.mspb.gov

MSPB Form 185, Page 1 (6/07) 

5 C.F.R. Parts 1201, 1208 and 1209
WHERE TO FILE AN APPEAL: You must file your appeal 

with the Board's regional or field office that is responsible for 

the geographic area where your duty station was located at 

the time the agency took the action or made the decision you 

are appealing. If you are appealing a nonselection under 

USERRA, VEOA, or in an IRA appeal, you should file with the 

regional or field office that is responsible for the location of the 

agency to which the application was made. If you are 

appealing a retirement or suitability decision by OPM, you 

must file your appeal with the Board's regional or field office 

that is responsible for the geographic area where you live. See 

5 C.F.R. Part 1201, Appendix II, 5 C.F.R. 1201.4(d), and 5 

C.F.R. 1201.22(a). If you have any questions, please contact 

the regional or field office with which you will file your appeal. 

WHEN TO FILE AN APPEAL: Except as indicated below, you 

must file your appeal during the period that begins on the day 

after the effective date, if any, of the action or decision you 

are appealing, and ends on the 30th calendar day after the 

effective date, or on the 30th calendar day after the date 

you received the agency's decision, whichever is later. 

(You may not file your appeal before the effective date of the 

action or decision.) If your appeal is late, it may be dismissed 

as untimely. 

The 30 calendar day filing time limit may be extended if you 

and the agency mutually agree in writing to try to resolve your 

dispute through an alternative dispute resolution (ADR) 

process before you file an appeal. If you and the agency 

reach such an agreement, you have an additional 30 calendar 

days—for a total of 60 calendar days—to file your appeal with 

the Board if you are unable to resolve the dispute through the 

ADR process. This extension of the time for filing does not 

apply to appeals that are subject to a filing time limit 

established by law, e.g., IRA and VEOA appeals. See 5 C.F.R. 

1201.22(b) and (c). 

If you are filing an IRA appeal, you must file no later than 65 

days after the date of the Office of Special Counsel (OSC) 

notice advising you that the Special Counsel will not seek 

corrective action, or within 60 days after the date you 

received the OSC notice, whichever is later. See 5 C.F.R. 

1209.5. 

If you are filing a USERRA appeal, there is no time limit for 

filing. See 5 C.F.R. 1208.12. If you file a USERRA complaint 

with the Department of Labor first, you must exhaust the 

procedures of the Department before you may file an appeal 

with the Board. 

If you are filing a VEOA appeal, you must file it within 15 

days after the date you received notice that the Department 

of Labor was unable to resolve the matter. See 5 C.F.R. 

1208.22. Note: Before filing with the Board, you must file 

a VEOA complaint with the Department of Labor, and the 

Department is allowed at least 60 days to try to resolve 

the matter. 

In all of the above instances, the date of filing is the date your 

appeal is postmarked, the date of the facsimile transmission, 

the date it is delivered to a commercial overnight delivery 

service, or the date of receipt in the regional or field office if 

you personally deliver it. 

HOW TO FILE AN APPEAL: You may file your appeal by 

mail, by facsimile, by commercial overnight delivery, by 

personal delivery, or by electronic filing. See 5 C.F.R. 

1201.22(d). You must submit an original and one copy of 

both your appeal and all attachments. You may supplement 

your response to any question on a separate sheet of paper, 

but if you do, please put your name and address at the top of 

each additional page. All of your submissions must be legible 

and on 8 1/2" x 11" paper. 

PLEASE SUBMIT ONLY THE ATTACHMENTS 

REQUESTED IN THIS FORM. You will have an opportunity 

to submit other documentary evidence later in the 

proceeding. 

Privacy Act Statement: This form requests personal information that is relevant and necessary to reach a 

decision in your appeal. The Merit Systems Protection Board collects this information in order to process appeals 

under its statutory and regulatory authority. Because your appeal is a voluntary action, you are not required to 

provide any personal information in connection with it. However, failure to supply the Merit Systems Protection 

Board with all the information essential to reach a decision in your case could result in the rejection of your appeal. 

You should know that the decisions of the Merit Systems Protection Board on appeals are final administrative 

decisions and, as such, are available to the public under the provisions of the Freedom of Information Act. 

Additionally, it is possible that information contained in your appeal file may be released as required by the 

Freedom of Information Act. Some information about your appeal will also be used in depersonalized form as a 

database for program statistics.

Public Reporting Burden: The public reporting burden for this collection of information is estimated to vary 

from 20 minutes to 4 hours, with an average of 60 minutes per response, including time for reviewing the form, 

searching existing data sources, gathering the data necessary, and completing and reviewing the collection of 

information. Send comments regarding the burden estimate or any other aspect of the collection of information, 

including suggestions for reducing this burden, to Office of the Clerk, Merit Systems Protection Board, 1615 M 

Street, N.W., Washington, DC 20419.

MSPB Form 185, Page 2 (6/07) 

5 C.F.R. Parts 1201, 1208, and 1209 
PART 1—Appellant and Agency Information 

Complete this part regardless of which type of appeal you are filing. Then proceed to Part 2 if you are 

appealing an agency personnel action or decision, to Part 3 if you are appealing an administrative decision or 

action affecting your retirement rights or benefits, or to Part 5 if you are filing an IRA appeal, USERRA appeal, 

or VEOA appeal. 

Please type or print legibly.

1. Name (last, first, middle) Please list your first name as it appears in your official personnel records. For 

example, if your first name is “William” on your official personnel records, please 

list it that way on the appeal form, not “Bill” or “Willy.” 

2. Present address (number and street, city, State, and Zip code) 

You must promptly notify the Board in writing of any change in your mailing address while your appeal is pending. 

Address: 

City, State, Zip code: 

3. Telephone Numbers (include area code) and E-Mail Address 

You must promptly notify the Board in writing of any change in your telephone number(s) or e-mail address while your appeal is 

pending. 

Home: ( ) Work: ( ) FAX: ( ) Other: ( ) 

E-mail Address:

4. Name and address of the agency that took the action or made the decision you are appealing (include bureau or division, street address, city, 

State and Zip code) 

Agency Name: 

Bureau: 

Address: 

City, State, Zip code:

5. Your Federal employment status at the time of the action or 

decision you are appealing: 

[ ] Permanent 

[ ] Seasonal 

[ ] None

[ ] Temporary 

[ ] Applicant

[ ] Term 

[ ] Retired

6. Type of appointment (if applicable): 

[ ] Competitive 

[ ] Postal Service 

[ ] Other describe):

[ ] Excepted 

[ ] SES

7. Your position, title, grade, and duty station at the time of the action or decision you are 

appealing (if applicable): 

Occupational Series or Cluster: Position Title: 

Grade or Pay Band: Duty Station: 

8. Are you entitled to veterans’ preference? 

See 5 U.S.C. 2108. 

[ ] Yes [ ] No 

MSPB Form 185, Page 3 (6/07) 

5 C.F.R. Parts 1201, 1208, and 1209 
PART 1—Appellant and Agency Information (continued)

9. Length of Federal service (if applicable): 10. Were you serving a probationary, trial, or initial service period at 

the time of the action or decision you are appealing? 

[ ] Yes [ ] No 

HEARING: You may have a right to a hearing before an administrative judge. If you choose to have a hearing, the administrative 

judge will notify you when and where it is to be held. If you do not want a hearing, the administrative judge will make a decision on 

the basis of the submissions of the parties. 

11. Do you want a hearing? [ ] Yes [ ] No 

12. I certify that all of the statements made in this form and any attachments are true, complete, and correct to the best of my 

knowledge and belief. 

Signature of Appellant or Representative: Date: 

_______________________________________________________ ________________________ 

PART 2—Agency Personnel Action or Decision (non-retirement) 

Complete this part if you are appealing an agency personnel action or decision (other than a decision or action 

affecting your retirement rights or benefits) that is appealable to the Board under a law, rule, or regulation. See

5 C.F.R. 1201.3(a) for a list of appealable personnel actions and decisions. If the personnel action or decision is 

appealable to the Board, you should have received a final decision letter from the agency that informs you of 

your right to file an appeal with the Board.

13. Check the box that best describes the agency personnel action or decision you are appealing. (If you are appealing more than one 

action or decision, check each box that applies.) 

[ ] Removal (termination after probationary or initial service period) [ ] Involuntary resignation

[ ] Termination during probationary or initial service period [ ] Involuntary retirement

[ ] Reduction in grade, pay, or band [ ] Denial of within-grade increase

[ ] Suspension for more than 14 days [ ] Furlough of 30 days or less

[ ] Failure to restore/reemploy/reinstate or improper 

restoration/reemployment/reinstatement

[ ] Separation, demotion or furlough for more than 30 days by 

reduction in force (RIF)

[ ] Negative suitability determination [ ] Other action (describe): 

13a. It is important that you attach a copy of the agency’s proposal letter and decision letter (if any). If an SF-50 or its equivalent was 

issued and is available, attach it now. DO NOT delay filing your appeal because you currently do not have any of these documents. 

You may submit them when they become available. Check the box(es) below to show which documents are attached to this form. Also

DO NOT include other documentation not requested in this Appeal Form. You will have other opportunities to submit evidence and 

argument after the appeal has been docketed. 

 [ ] Agency’s proposal letter [ ] Agency’s decision letter [ ] SF-50 

14. Date you received the agency’s proposal 

letter (if any) (month, day, year) 

15. Date you received the agency’s final 

decision letter (if any) (month, day, year) 

16. Effective date (if any) of the agency 

action or decision (month, day, year): 

17. Prior to filing this appeal, did you and the agency mutually agree in writing to try to resolve the matter through an alternative dispute 

resolution (ADR) process? 

[ ] Yes (Attach a copy of the agreement) [ ] No 

MSPB Form 185, Page 4 (6/07) 

5 C.F.R. Parts 1201, 1208, and 1209 
PART 2—Agency Personnel Action or Decision (non-retirement) (continued)

18. Explain briefly why you think the agency was wrong in taking this action or making this decision. 

19. What action would you like the Board to take in this case (i.e., what remedy are you asking for)? 

20. With respect to the agency personnel action or decision you are appealing, have you, or has anyone on your behalf, filed a 

grievance under a negotiated grievance procedure provided by a collective bargaining agreement? 

[ ] Yes [ ] No

If “Yes,” attach a copy of the grievance, enter the date it was filed (month, day, year), and enter the place where it was filed if different from 

your answer to question 4 in Part 1: 

Agency Name: Date Filed: 

Bureau: 

Address: 

City, State, Zip code: 

If a decision on the grievance has been issued, attach a copy of the decision and enter the date it was issued (month, day, year): 

PART 3—OPM or Agency Retirement Decision or Action 

Complete this part if you are appealing an administrative decision or action by the Office of Personnel 

Management (OPM) or a Federal agency affecting your rights or benefits under the Civil Service Retirement 

System (CSRS) or the Federal Employees’ Retirement System (FERS). See 5 C.F.R. 1201.3(a)(6). If the 

decision or action is appealable to the Board, you should have received a final decision from OPM or the 

agency that informs you of your right to file an appeal with the Board.

21. In which retirement system are you enrolled? 

[ ] CSRS [ ] CSRS Offset [ ] FERS 

[ ] Other, describe:

22. Are you a: 

[ ] Current Employee [ ] Annuitant 

[ ] Surviving Spouse 

[ ] Other, describe: 

MSPB Form 185, Page 5 (6/07) 

5 C.F.R. Parts 1201, 1208, and 1209 
PART 3—OPM or Agency Retirement Decision or Action (continued) 

23. If retired, date of retirement, or if unknown, approximate date 

(month, day, year): 

24. Are you appealing an action or decision concerning a retirement 

coverage error under the provisions of the Federal Erroneous 

Retirement Coverage Corrections Act (FERCCA)? See 5 CFR 

Part 839. 

[ ] Yes [ ] No

25. Describe the retirement decision or action you are appealing. 

Answer either Question 26 OR Question 27, whichever applies to your appeal. 

26. If you are appealing an OPM retirement decision, have you received a final or reconsideration decision from OPM? 

[ ] Yes (Attach a copy) [ ] No 

If “Yes,” on what date did you receive the OPM decision (month, day, year)? 

Provide the OPM processing (CSA or CSF) number in your appeal: 

27. If you are appealing a retirement decision or action by a Federal agency other than OPM, have you received a final decision from that 

agency? 

[ ] Yes (Attach a copy) [ ] No 

If “Yes,” on what date did you receive the agency decision (month, day, year)? 

28. Why do you think the decision or action was wrong? 

29. What action would you like the Board to take in this case (i.e., what remedy are you asking for)? 

PART 4—Other Claims 

If you completed Part 2 to appeal an agency personnel action or decision or Part 3 to appeal an administrative 

decision or action affecting your retirement rights or benefits, in most cases, you also may raise certain other 

claims in connection with that appeal. Such claims must be raised no later than the close of the conference(s) 

held to define the issues in your appeal. See 5 C.F.R. 1201.24(b). If you wish to raise any of these claims at 

this time, check the appropriate box (or boxes) in this part to indicate the claim(s) you are raising. Provide 

information supporting the claim(s), including any information required by the Board’s regulations for the 

specific type of claim(s), on a separate sheet of paper and attach it to this form. If you prefer, you may raise 

such claims later—but no later than the close of the conference(s) on your appeal. Remember that you are 

responsible for proving each claim you raise. 

MSPB Form 185, Page 6 (6/07) 

5 C.F.R. Parts 1201, 1208, and 1209
PART 4—Other Claims (continued) 

30. Check the appropriate box (or boxes) for any claim(s) that you wish to raise at this time in connection with the action or decision you 

are appealing in Part 2 or Part 3, and provide supporting information as an attachment to this form: 

[ ] A claim that the agency made errors in applying required procedures (harmful error), that the agency action or decision was the result 

of a prohibited personnel practice, or that the agency action or decision was not in accordance with law. See 5 C.F.R. 1201.56(b) 

and (c)(3). For prohibited personnel practice claims, also see 5 U.S.C. 2302(b). 

[ ] A claim that the agency action or decision was the result of prohibited discrimination (race, color, religion, sex, national origin, 

disability, age). See 5 C.F.R. 1201.151 and 1201.153. If you previously filed a formal discrimination complaint with the agency 

concerning the action or decision you are appealing, attach a copy of the complaint. If the agency has issued a final decision on 

your discrimination complaint, attach a copy of the decision. 

[ ] A claim that the agency action or decision was based on whistleblowing. See 5 U.S.C. 2302(b)(8), 5 C.F.R. 1209.2(b)(2), and 5 

C.F.R. 1209.6(a). If you previously sought corrective action from the Office of Special Counsel (OSC) concerning the same 

disclosure(s) and the same agency action or decision you are appealing, attach a copy of your request to OSC for corrective 

action. If you have received written notice from OSC of your right to appeal to the Board, attach a copy of the OSC notice. Also see 

5 C.F.R. 1209.8 and 1209.9 if you wish to request a stay of the agency action or decision. 

[ ] A claim that the agency violated your rights under the Uniformed Services Employment and Reemployment Rights Act (USERRA) 

(other than rights related to the Thrift Savings Plan for Federal employees) in taking the action or making the decision. See 38 U.S.C. 

4322 and 4324, 5 C.F.R. 1208.11, and 5 C.F.R. 1208.13. If you previously filed a USERRA complaint with the Department of Labor 

(DOL) on this matter, attach a copy of the complaint. If you have received written notice from DOL that your USERRA complaint 

could not be resolved, attach a copy of the DOL notice. 

[ ] A claim that the agency violated a law or regulation relating to veterans’ preference in taking the action or making the decision. 

IMPORTANT: If you choose to make your veterans’ preference claim in connection with this appeal of an agency action or decision, 

you may NOT also pursue a complaint under the redress procedure of the Veterans Employment Opportunities Act (VEOA) with DOL 

at the same time as the appeal. See 5 U.S.C. 3330a(e) and 5 C.F.R. 1208.26. 

PART 5—IRA Appeal, USERRA Appeal, or VEOA Appeal 

Complete the applicable question in this part ONLY if you are filing an Individual Right of Action (IRA) appeal 

under the Whistleblower Protection Act, a Uniformed Services Employment and Reemployment Rights Act 

(USERRA) appeal, or a Veterans Employment Opportunities Act (VEOA) appeal. 

VEOA Appeals under 5 U.S.C. 3330a: Preference eligibles (defined in 5 U.S.C. 2108) allege that a Federal 

agency violated their rights under any statute or regulation relating to veterans’ preference. See 5 C.F.R. 

1208.21. Before you may file a VEOA appeal with the Board, you must first file a VEOA complaint with DOL 

and allow DOL at least 60 days to try to resolve the matter. See 5 C.F.R. 1208.21. 

USERRA Appeals under 38 U.S.C. 4324: Persons allege a violation of their rights and benefits under chapter 43 

of title 38, U.S.C., e.g., by failure to reemploy them after a uniformed service period, or by discrimination based 

on that service or on their application or obligation to provide uniformed service. See 5 C.F.R. Part 1208. To 

pursue redress for a USERRA violation, you may either file a USERRA complaint with the Department of Labor 

(DOL) or file an appeal with the Board. However, if you first file a USERRA complaint with DOL, you must 

exhaust DOL procedures before you may file an appeal with the Board. See 5 C.F.R. 1208.11.

IRA Appeals: These are authorized by 5 U.S.C. 1221(a) with respect to personnel actions listed in 5 U.S.C. 

2302(a)(2) that are allegedly threatened, proposed, taken or not taken because of the appellant’s 

whistleblowing. Whistleblowing is the disclosure of information that the individual reasonably believes shows a 

violation of law, rule, or regulation, gross mismanagement, gross waste of funds, abuse of authority, or 

substantial and specific danger to public health or safety. See 5 C.F.R. Part 1209. If the action is not otherwise 

appealable to the Board, you must first file a whistleblower complaint with the Office of Special Counsel (OSC) 

and exhaust the procedures of that office, before you may file an IRA appeal with the Board. See 5 C.F.R. 

1209.2(b)(1).

MSPB Form 185, Page 7 (6/07) 

5 C.F.R. Parts 1201, 1208, and 1209 
Answer Question 31 ONLY if you are filing an IRA appeal. 

31. Have you filed a complaint with OSC regarding the same disclosure(s) and the same agency action(s) or decision(s) underlying your IRA 

appeal? 

[ ] Yes [ ] No 

 

If “Yes,” attach a copy of your complaint to OSC, provide the information required by the Board’s regulations at 5 C.F.R. 1209.6(a) as an 

attachment to this form, and explain what action you would like the Board to take in this case. If you have received written notice from OSC 

of your right to file an IRA appeal with the Board, attach a copy of the OSC notice. Also see 5 C.F.R. 1209.8 and 1209.9 if you wish to 

request a stay of the agency action or decision. 

Answer Question 32 ONLY if you are filing a USERRA appeal. 

32. Have you previously filed a USERRA complaint with DOL on this matter? [ ] Yes [ ] No 

If “Yes,” attach a copy of your USERRA complaint to DOL, provide the information required by the Board’s regulations at 5 C.F.R. 

1208.13(a) as an attachment to this form, and explain what action you would like the Board to take in this case. If you have received 

written notice from DOL that your USERRA complaint could not be resolved, attach a copy of the DOL notice. If your USERRA 

complaint was referred to OSC and OSC declined to represent you, attach a copy of the OSC notice. If OSC is representing you in 

your USERRA appeal, at number 34 below, enter “Office of Special Counsel” as your designated representative. 

If “No,” provide the information required by the Board’s regulations at 5 C.F.R. 1208.13(a) as an attachment to this form, and explain 

what action you would like the Board to take in this case.

Answer Question 33 ONLY if you are filing a VEOA appeal. 

33. Have you filed a VEOA complaint with DOL and allowed DOL at least 60 days to try to resolve this matter? [ ] Yes [ ] No 

If “Yes,” attach a copy of your VEOA complaint to DOL, provide the information required by the Board’s regulations at 5 C.F.R. 

1208.23(a) as an attachment to this form, and explain what action you would like the Board to take in this case. If you have received 

written notice from DOL that your VEOA complaint could not be resolved, attach a copy of the DOL notice and provide the date you 

received it. If more than 60 days have passed since you filed your VEOA complaint with DOL and your complaint has not been resolved, 

attach a copy of your notice to DOL stating your intent to appeal to the Board and provide the date you sent it to DOL. 

MSPB Form 185, Page 8 (6/07) 

5 C.F.R. Parts 1201, 1208, and 1209 
PART 6—Designation of Representative 

Complete this part to designate an organization or a person who has agreed to represent you in your appeal 

before the Board. If you are representing yourself, do NOT complete this part. By designating a 

representative, you agree to allow the Board to give your representative all information concerning the appeal. 

Any changes of this designation must promptly be sent in writing to the MSPB office handling the 

appeal and to the other party. See 5 C.F.R. 1201.31. 

34. Do you wish to designate an individual or organization to represent you in this proceeding before the Board? (You may designate a 

representative at any time. However, the processing of your appeal will not normally be delayed because of any difficulty you may have in 

obtaining a representative.) 

[ ] Yes (Complete the information below and sign) [ ] No 

DESIGNATION: 

"I hereby designate ____________________________________ to serve as my representative during the course of this appeal. I 

understand that my representative is authorized to act on my behalf. In addition, I specifically delegate to my representative the authority to 

settle this appeal on my behalf. I understand that any limitation on this settlement authority must be filed in writing with the Board. 

Representative's address (number and street, city, State and Zip code). 

Address: 

City, State, Zip code: 

Representative's telephone numbers (include area code) and e-mail 

address: 

Office: 

FAX: Other: 

E-mail address: 

SIGN BELOW TO MAKE YOUR DESIGNATION OF REPRESENTATIVE EFFECTIVE 

________________________________________________________ ___________________ 

Appellant’s Signature Date 

MSPB Form 185, Page 9 (6/07) 

5 C.F.R. Parts 1201, 1208, and 1209