Red Flags Identity Theft Incident Report Complete this form when an identity theft incident or attempt occurs. University employees must complete this Report upon becoming aware of an incident of identity theft or attempt. You must have JavaScript enabled to use this form. Contact Information of Individual Reporting the Incident Name First Last Title Email Telephone Department/Unit Incident Details Information message Please do not include any personally identifiable information (PII) or sensitive data on this form, to specifically include, social security numbers, credit card numbers, bank account numbers, driver's license numbers, or documentation, such as, personal financial records. Date of Incident (if available) Time of Incident Date Reported Describe the type of information/account compromised and the red flag Describe how it was discovered How did this activity occur? In Person Email Phone Fax Other… Enter other… Who else or what department has been notified of the incident? Has the person(s) whose identity is in question been notified? Yes No If yes, by whom? Has this been reported to law enforcement? Yes No If yes, please provide the case number below and email a copy of the police report to [email protected] Mitigation Describe the mitigation process or actions This information is required. Please submit attachments via email to [email protected].
