Initial Appeal

OMB No. XXX-XXXX, Exp. MM/DD/YYYY

Privacy Act Statement
AUTHORITY: MSPB may hear appeals of Federal agency actions only when it has been authorized
to do so by law, rule, or regulation. 5 U.S.C. § 7701(a); 5 U.S.C. § 1204.
PRINCIPAL PURPOSE(S):
This information is being collected for the primary purposes of
adjudicating the appeals and matters described above, rendering MSPB decisions in these matters,
and enabling case parties to have access to MSPB’s electronic filing system. Additionally, some
information about the appeal or case is used in depersonalized form for statistical purposes.

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ROUTINE USE(S): The information on this form may be shared outside of MSPB as generally
permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes sharing
the information as necessary and authorized by routine uses published in MSPB/GOVT – 1 Appeals
and Case Records, 77 Fed. Reg. 65206 (Oct. 25, 2012), and upon written request, by agreement, or
as required by law. MSPB decisions are available to the public under the provisions of the Freedom
of Information Act (FOIA), 5 U.S.C. § 552, and are posted to MSPB’s public website. Other
documents from individual appeal and case files may also be made available as required by FOIA.

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DISCLOSURE: The disclosure of information on this form is voluntary; however, failure to provide
the information requested may delay or prevent the proper docketing of a matter and/or, the
adjudication of a matter, which could result in the dismissal or delay of your appeal or matter, and/or
prevent access to MSPB’s e-Appeal system.
Paperwork Burden Disclosure Notice

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Public reporting burden for this data collection is estimated to vary from 60 and 120 minutes, with an
average of 90 minutes per response. The burden estimate includes the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and submitting this form. You are not required to respond to this collection of
information unless a valid Office of Management and Budget (OMB) control number is displayed on
this form. 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 of the Board, Merit
Systems Protection Board, 1615 M Street, NW, Washington, DC 20419; by fax to 202-653-7130; or
by email to [email protected].

MSPB Form 185, Page 2 (XX/XX), 5 C.F.R. parts 1201, 1208, and 1209