This page uses JavaScript and requires a JavaScript enabled browser.Your browser is not JavaScript enabled.
Loading...
Skip to main content
Data Breach Reporting Form
*
Please select one of the following to proceed
You are a private person or business reporting a data breach pursuant to General Business Law § 899-aa(2), and/or are a “Covered Entity” required to provide notice to the U.S. Department of Health and Human Services under 45 C.F.R. § 164-408, pursuant to General Business Law § 899-aa(9). Notifications pursuant to General Business Law § 899-aa(2) will also be sent to the New York Department of State and the New York State Police in satisfaction of your requirement to notify those agencies.
You are a New York State government agency or entity reporting a data breach pursuant to New York State Technology Law § 208. Your submission will also be sent to the New York Department of State.
You must provide separate notice to the New York State Office of Information Technology Services,
as required by New York State Technology Law § 208-7(a).
You are a private person or business reporting an inadvertent disclosure of over 500 New York residents pursuant to General Business Law § 899-aa (2)(a), for which you have determined will not likely result in misuse of the information.
Next >
OK
OK
Cancel