Report a Data Breach

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You are a business reporting a data breach pursuant to 73 P.S. § 2303(c.1).

You are a Pennsylvania government agency or entity reporting a data breach pursuant to 73 P.S. § 2303(a.1).

You are a person that is a victim of a data breach.

Please continue on our Identity Theft page.

Name(Required)

First Last

Title

Your Firm/Organization Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Enter Email Confirm Email

Phone(Required)

Entity that experienced the Breach

Entity Name(Required)

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Entity Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address

Phone Number

Website

Organization Type(Required)

Breach Date Details

Start Date(Required)

End Date(Required)

Date learned of unauthorized access to network(Required)

Date learned private information was accessed and acquired(Required)

Date affected Pennsylvania residents were notified(Required)

Manner of notification to affected persons (Select All That Apply)

Written

Electronic

Telephone

Substitute notice

List dates of any previous (within 12 months) breach notifications

Identity theft protection service offered?(Required)

Yes

No

Summary of incident(Required)

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Do you have supporting documents?

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Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB, Max. files: 25.

In filing this report, I understand that:

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The Attorney General may share information contained in this notification with other state, local and/or federal government agencies to coordinate law enforcement. In addition, the Attorney General may use information contained in this notification in legal proceedings to establish violations of law.

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I understand that any false statement made in connection with this report was made pursuant to and under penalty of 18 Pa.C.S. § 4904, relating to unsworn falsification to authorities.

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By typing my full name below, I certify that the above complaint is true and accurate to the best of my knowledge and that all documents attached are true and accurate copies of the originals.

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Report a Data Breach

Entity that experienced the Breach

Breach Details

Breach Date Details

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