U.S. Department of Health and Human Services
Office for Civil Rights
Breach Portal: Notice to the Secretary of HHS Breach of Unsecured Part 2 Records

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Notice to the Secretary of HHS
Breach of Unsecured Part 2 Records

Form Approved: OMB No. 0945-0010
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 Part 2 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
  • HIPAA Breach Report Information
  • 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 Breach of Unsecured Part 2 Records Notification process, or OCR's investigative process, please send us an email at OCRbreachreportingfeedback@hhs.gov.


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