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

Person sitting at a laptop

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 (PDF)

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

If you have questions or would like to provide feedback about the Health Insurance Portability and Accountability Act (HIPAA) Breach Notification process, or OCR's investigative process, please send us an email at OCRbreachreportingfeedback@hhs.gov.


Session timeout warning!

Your session will be timeout in seconds


Please select any key to remain on page. Failure to do so will result in all entered data to be deleted.

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