Get New York State Security Breach Reporting Form Pursuant To The Information Security Breach And

Filling out the New York State Security Breach Reporting Form is an essential step for entities that have experienced a data breach. This guide will provide you with clear, step-by-step instructions to complete the form efficiently and accurately.

Follow the steps to complete the reporting form.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Fill in the name and address of the entity that owns or licenses the computerized data impacted by the breach. Ensure that all fields are accurately completed, including street address, city, state, and zip code.
3. Provide your name, title, and the date of submission, along with the firm name if applicable.
4. Enter your telephone number and email address for further correspondence.
5. Describe your relationship to the entity whose information was compromised.
6. Select the type of organization from the available options, such as governmental entity or educational institution.
7. Indicate the number of persons affected by the breach, including the total number as well as the number of New York State residents.
8. If the number of affected New York State residents exceeds 5,000, check whether the consumer reporting agencies have been notified.
9. Fill in the relevant dates for when the breach occurred, was discovered, and when consumers were notified.
10. Select the applicable options for the description of the breach and indicate what information was acquired.
11. Provide details regarding the manner of notification to affected persons and attach a copy of the notice template.
12. List any previous breach notifications sent within the past 12 months.
13. Indicate whether identity theft protection services are offered, providing the duration, provider name, and a brief description of the services.
14. Once all fields are completed, save any changes made to the form. You may choose to download it for your records, print a copy, or share it as necessary.

Complete and submit the New York State Security Breach Reporting Form online to ensure compliance and protect affected individuals.