The purpose of this form is to inform University risk managers of storage practices for restricted data types in all areas of the University. This information will be used to direct educational and risk reduction efforts to those situations that present the most significant risks to the University's reputation and finances. Submit this form multiple times as needed: • for each collection containing Social Security Numbers that you possess or control access to • for each collection containing Social Security Numbers that serves a different business purpose • for each medium (paper, electronic, microfiche, etc.) that the same collection serving the same business purpose may be recorded on Date* Date Format: MM slash DD slash YYYY Is this a revision of a previous submission?*YesNoContact InformationName* First Last Title*Division/School*Department*Intramural Box Number*Email Address* Phone Number*About the CollectionStorage Medium*ElectronicPaperMicroficheIs the data encrypted?YesNoNot sureName of Data Collection, Application, or System*Is this collection stored in a computer located in a UR data center?*YesNoDescribe the physical location (building and room) where the collection is stored.Describe the physical security measures used to protect the collection.Describe any software control and/or technology used to protect the collection.Restricted Data ClassesIs a Social Security Number — full or any significant part (e.g., last 4 digits) — contained in this collection?*YesNoNot sureState the legal or University purpose that justifies the retention of Social Security Numbers in this collection.*Approximately how many records in this collection contain Social Security Numbers?*101005001000+Are credit or debit card numbers also contained in this collection?*YesNoNot sureIs any security, access, or password code for these cards also stored in this collection?*YesNoNot sureAre any Driver's License Numbers or NYS Non-Driver Identification Numbers also stored in this collection?*YesNoNot sure This iframe contains the logic required to handle Ajax powered Gravity Forms.