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pdfSafeguards Rule Security Event Reporting Form
The Safeguards Rule requires covered financial institutions to report to the FTC security events affecting 500 or
more people. Complete this form and email it to the FTC at [email protected]. Your report may
be made public.
Name of Affected Financial Institution
Contact Person at Affected Financial Institution
Name
Email Address
Date Range of Security Event
Phone Number
Number of People Affected
Type of Information Involved in the Security Event
Summary of Security Event (Additional documents may by attached to your email.)
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| File Type | application/pdf |
| File Title | Safeguards Rule Security Event Reporting Form |
| Author | Federal Trade Commission |
| File Modified | 2023-06-23 |
| File Created | 2023-05-17 |