Form NCUA External Cyber Incident Report

External Cyber Incident Report
Report any Incident you have.

New or Modified Incident
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Is this a New, Modified, or Corrected Cyber Incident report? 
New

Individual Reporting Incident
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Individual's Name (Who is submitting this report?) 

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Email Address (Submitter's Email Address) 

Phone Number (Submitter's Phone Number) 
XXX-XXX-XXXX

Preferred Method of Contact 
Phone
Email

Credit Union Information
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Credit Union Name 

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Charter Number 

Credit Union Address 

City 

State 

Zip Code 

Cyber Incident Point of Contact
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Point of Contact Name 

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Email Address 

Phone Number 
XXX-XXX-XXXX

Preferred Method of Contact 
Phone
Email

Cyber Incident Information
Date Incident was Detected 
Please use the Clock icon in the Date picker to update the Hours and Minutes of an Incident
Reported/Occured Date/Time.
YYYY-MM-DD HH:mm:ss

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Date Incident Occured 
YYYY-MM-DD HH:mm:ss

Date Incident Reported to NCUA 
2024-10-28 11:54:00

If law enforcement or other agencies were notified, when?

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Date Critical Infrastructure Security Agency (CISA) Notified
YYYY-MM-DD HH:mm:ss

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Date Federal Bureau of Investigation (FBI) / Field Office Notified
YYYY-MM-DD HH:mm:ss

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Date Financial Crimes Enforcement Network (FINCEN) / SAR Filing Notified
YYYY-MM-DD HH:mm:ss

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Date Internet Crime Complaint Center (IC3) Notified
YYYY-MM-DD HH:mm:ss

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Date Office of Cybersecurity and Critical Infrastructure Protection (OCCIP) Notified
YYYY-MM-DD HH:mm:ss

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Date State Regulator Notified
YYYY-MM-DD HH:mm:ss

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Other Agency Notified (Specify below)

Date Other Agency Notified
YYYY-MM-DD HH:mm:ss

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Reportable Cyber Incident Details
The credit union has experienced a Cyber Incident resulting in: 
Check all that apply.

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A substantial loss of confidentiality, integrity, or availability of a network or member information
system.
A disruption of business operations, vital member services, or a member information system
resulting from a cyberattack or exploitation of vulnerabilities.
A disruption of business operations or unauthorized access to sensitive data facilitated through
a compromise of a credit union service organization, cloud service provider, or other third-party
data hosting provider or by a supply chain compromise.
Description of the event:

Select the impacted Services, Functions, Technologies, or Other: 
Select all that apply

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Loss of Confidentiality, Integrity, or Availability
Has Member Sensitive data been accessed, changed, deleted, exposed, exfiltrated, or otherwise
impacted? 
-- None --

Business Operations are:
-- None --

Vital Member Services are:
-- None --

Initial Access/Point of Entry
If known, what was the initial point of access/entry? 
-- None --

Incident Type

Notices and Compliance Statements

508 COMPLIANCE: The National Credit Union Administration is committed to providing access to all individuals
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conform to the Section 508 of the Rehabilitation Act(Opens new window) (as amended), which requires that all
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using assistive technology, such as screen readers, eye tracking devices, or voice recognition software, or for
questions or information about this site's accessibility, send an email to [email protected].

PRIVACY NOTICE: The information you provide will be used to track and manage reported cyber incidents. The
NCUA securely maintains all personally identifiable information stored in CICURS and only shares it outside of
the NCUA if required by law or regulation. For additional information, please contact [email protected].

PAPERWORK REDUCTION ACT STATEMENT: According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless it displays a valid OMB control number. Comments
concerning the accuracy of the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, should be addressed to the National Credit Union Administration, ATTN:
PRA Cl
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Individual's Name (Who
Email Address (Submitte
Credit Union Name

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