U.S. Department of Health and Human Services
Office for Civil Rights
Breach Portal: Notice to the Secretary of HHS Breach of Unsecured Protected Health Information

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Please Note: The Breach Notification Portal will be offline for maintenance from Fri Nov 24 10:00 PM EST to Sat Nov 25 07:00 AM EST. Any information being entered when the Portal is taken off-line will be lost.

Notice to the Secretary of HHS
Breach of Unsecured Protected Health Information

Form Approved: OMB No. 0945-0001
This site is available as we continuously work to make improvements to better serve the public. Should you need assistance with this site or have any questions, please email ocrprivacy@hhs.gov or call us toll-free: (800) 368-1019, TDD toll-free: (800) 537-7697.

To file a breach report, please enter information in the wizard pages below. A field with an asterisk (*) before it is a required field. Download Sample Form

  • General
  • Contact
  • Breach
  • Notice of Breach and Actions Taken
  • Attestation
  • Summary
General: Please supply the required general information for the breach.
What type of breach report are you filing?


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U.S. Department of Health & Human Services - 200 Independence Avenue, S.W. - Washington, D.C. 20201
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