Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the reporting form and open it in your preferred document editing tool.
2. Begin by filling in your personal information in the 'Reporting Individual/Entity’s Information' section. This includes your name, title, office phone number, mobile phone number (if applicable), and email address.
3. Indicate if a third-party contractor is involved in the incident. If yes, provide a brief explanation about their role.
4. Complete the section regarding the Educational Agency impacted by the incident. Fill in the name, address, city, state, zip code, office phone number, email, and select the type of organization.
5. Document the relevant dates, including the date of the incident, date of discovery, and any notifications to affected individuals.
6. In the ‘Description of Incident’ section, select all applicable options that describe the incident that occurred.
7. Detail the ‘Information about Impacted Data’ by selecting all relevant categories that apply to the affected data.
8. Provide information regarding the impacted systems, including a description of critical and non-critical systems affected, as well as information about backup systems.
9. Respond to the notification requirements based on whether alerting affected individuals is necessary, and describe how notifications were performed.
10. Document any reporting to oversight agencies, including which government agency was notified and the reasons for that notification.
11. In the ‘Detection and Response’ section, provide details about how the incident was detected, any root causes identified, and the steps taken to address the incident.
12. Finally, summarize the incident in the ‘Additional Information’ section to provide a brief account of the event.
13. After thoroughly reviewing all entered information, you may save changes, download, print, or share the completed form.

Complete your NY NYSED Data Incident Reporting Form online today to ensure a comprehensive report.