**U.S. Office of Special Counsel**

1730 M Street NW, Suite 218

Washington, DC 20036-4505

(202) 804-7163  certification@osc.gov

1. In addition to submitting this form to request certification and recertification (every three years), agencies will need to complete an annual certification checklist to ensure ongoing compliance.

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: Click or tap here to enter text.

Title: Click or tap here to enter text.

Email: Click or tap here to enter text.

Phone: Click or tap here to enter text.

Address (to send certificate): Click or tap here to enter text.

**Agency or Office Certifying:**Click or tap here to enter text.

	Agency and OIG ☐

	Agency ☐

	OIG ☐

	Component (please indicate parent agency) Click or tap here to enter text.

Contact Information

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 Diversity, Outreach, and Training Unit, which can be reached at 202-804-7163 or certification@osc.gov. 

General Information

**U.S. Office of Special Counsel’s**

**Certification Program Compliance Form**

4. SUPERVISORY TRAINING

A. Please attach the annual notice that was provided to all employees.

B. On what date and how (e.g., email) was this information provided to employees? Click or tap here to enter text.

*Agencies shall provide annual notice to all employees on rights and remedies regarding PPPs and filing whistleblower disclosures along with access to written materials (described above). An example of an agency head’s letter sent to agency employees is available on the OSC**website**.*

3. ANNUAL EMPLOYEE NOTIFICATION

A. Please attach the written materials that you are providing to new employees in their orientation packets.

B. On what date were materials added to orientation packets? Click or tap here to enter text.

*Written materials on the PPPs and filing whistleblower disclosures and OSC’s role in enforcing the laws within its jurisdiction should be provided in new employee orientation packets within 180 days of employment. OSC has created an outline of PPP rights and remedies that can be printed or sent via email. The materials are available on OSC’s**website**.*

2. NEW EMPLOYEE NOTIFICATIONS

A. Please attach the posters displayed throughout the agency locations.

B. On what date(s) were posters displayed throughout agency locations: Click or tap here to enter text.

*Agencies should post the laws regarding prohibited personnel practices (PPPs), whistleblowing, and whistleblower retaliation. The posters should be displayed in all personnel and EEO offices and/or in other prominent places throughout the agency.*

Comprehensive PPP Training

*Each agency, in consultation with OSC, should provide training every three years to all managers and supervisors to assure their understanding and implementation of their responsibilities under 5 U.S.C. § 2302. OSC offers in-person and virtual training to assist agencies with fulfilling this requirement.*

1. POSTINGS AT AGENCY LOCATIONS

Requirement Compliance Information

*The Dr. Chris Kirkpatrick Whistleblower Protection Act of 2017 requires agencies to train supervisors, in consultation with OSC, on how to respond to complaints alleging a violation of whistleblower protections. OSC has developed a new PowerPoint presentation and offers in-person and virtual training to satisfy this requirement.*

A. What method was used to train supervisors? If possible, please attach a copy of the training materials. If the agency modified OSC’s slides or developed new materials, please include the date on which OSC approved the materials. Click or tap here to enter text.

B. Approximate number of supervisors trained: Click or tap here to enter text.

C. On what date(s) were supervisors trained? Click or tap here to enter text.

Signature of official responsible for implementing OSC’s Certification Program:

Confirmation of Completion

A. Provide the website address where employees can find a link to the OSC website and a screenshot of the link on the intranet page (if applicable). Click or tap here to enter text.

*Each agency should provide a link from its public-facing website and intranet site to the OSC website:**www.osc.gov**.*

5. LINK TO OSC’S WEBSITE

Annual Supervisory Training

A. What method was used to train supervisors? If possible, please attach a copy of the training materials. If OSC did not provide the training, please include the date on which OSC approved the materials. Click or tap here to enter text.

B. Approximate number of supervisors at your agency: Click or tap here to enter text.

C. Approximate number of supervisors trained: Click or tap here to enter text.

D. On what date(s) were supervisors trained? Click or tap here to enter text.

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