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Affected business entity name

Affected business entity address

City

State

Zip code

What product or service does the affected business provide?

Reporting entity name (if different than affected entity)

Relationship to affected business

Contact person's name

Contact person's title

Phone number

Date breach incident began

Date breach discovered

Date breach contained

Were Arkansas residents affected? If yes, how many?

Explanation of personal information involved

What steps has the business entity taken to address the incident?

The following are examples of the type of information that you should provide:
Internal investigation
Forensic investigation
Notified law enforcement
Frozen compromised accounts
Amended administrative safeguards (such as company practices, policies or procedures)
Amended technical or physical safeguards
Deleted information
Other

Was notice provided to affected consumers?

Provide the date(s) that notice was provided to consumers.

Provide a sample copy of the notice letter.

Do you have supporting documents?