Form MSPB-185 MSPB Form 185

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
(www.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:
ƒ An appeal of a Federal agency personnel action or
decision that is appealable to the Board under a law,
rule, or regulation;
ƒ 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;
ƒ An Individual Right of Action (IRA) appeal under the
Whistleblower Protection Act (WPA);
ƒ An appeal under the Uniformed Services Employment
and Reemployment Rights Act (USERRA); or
ƒ 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:
ƒ

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

ƒ

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

ƒ

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 the
MSPB e-Appeal website—https://e-appeal.mspb.gov
MSPB Form 185, Page 1 (0_/05)
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 (0_/05)
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.
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.”

1. Name (last, first, middle)

1a. Last 4 Digits of Your Social Security Number _ _ _ _

(mandatory).

The Merit Systems Protection Board requires that you provide it with the last four digits of your Social Security number. This
information will be used solely for identification purposes in the processing of your appeal. Failure to provide this information
may result in the delay or non-processing of your appeal.
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

[ ] Temporary

[ ] Term

[ ] Seasonal

[ ] Applicant

[ ] Retired

6. Type of appointment (if applicable):
[ ] Competitive

[ ] Excepted

[ ] Postal Service

[ ] SES

[ ] Other describe):

[ ] None

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 (0_/05)
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
14. Date you received the agency’s proposal
letter (if any) (month, day, year)

[ ] Agency’s decision letter
15. Date you received the agency’s final
decision letter (if any) (month, day, year)

[ ] SF-50
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 (0_/05)
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?
[ ] No

[ ] Yes

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?

22. Are you a:

[ ] CSRS

[ ] Current Employee

[ ] CSRS Offset

[ ] Other, describe:

[ ] FERS

[ ] Annuitant

[ ] Surviving Spouse
[ ] Other, describe:

MSPB Form 185, Page 5 (0_/05)
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 (0_/05)
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) or veterans described in
38 U.S.C. 3304(f)(1) 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 (0_/05)
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 (0_/05)
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).

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

Address:
Office:
City, State, Zip code:

FAX:

Other:

E-mail address:

SIGN BELOW TO MAKE YOUR DESIGNATION OF REPRESENTATIVE EFFECTIVE

________________________________________________________

___________________

Appellant’s Signature

Date

MSPB Form 185, Page 9 (0_/05)
5 C.F.R. Parts 1201, 1208, and 1209