Data Breach Notification Form

Pursuant to A.R.S. § 18-552(B)(2)(b), a person that owns or licenses computerized data that experiences a system security breach may provide notice of the data breach to the Arizona Attorney General using this form.  Defined terms (e.g., Person, Breach, Security Incident, Personal Information, Nationwide Consumer Reporting Agency, etc.) that are used below shall have the meanings set forth in A.R.S. § 18-551.

Notifications provided to the Attorney General using this form are confidential pursuant to A.R.S. § 44-1525 and are exempt from disclosure under A.R.S. § 39-101 et seq., but may be used by the Attorney General to investigate the data breach or any related incidents or conduct.

Approximate date(s) of Breach:

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