Personally Identifiable Information Checklist

Your Name

First Last

Your Email

Privacy Contact Email*

If someone has a privacy concern about your website, what email address should they used to contact you? This will be published as a part of your policy.

Business/Organization Name

Personally identifiable information (PII) can be very basic. For instance, if someone emails you, you now have their email address. If they call you, you may now have their phone number.

Do you receive information from any person or organization outside of your home state?

Yes
No

What States?

What US states do you receive PII from? It’s better to add states where you might collect info than to exclude states and have to keep this list updated.

International PII

Do you receive any personally identifiable information for persons outside of the United States?

Yes
No

Revenue more than $25,000,000?

Do you have annual gross revenue of more than $25,000,000? (Certain states have privacy laws that have higher requirements for businesses with more than $25M in revenue.)

Yes
No

Check the types of Personally Identifiable Information (PII) that your organization collects

What other information do you collect?

Do you collect any of these types of insurance information?

Policy number
Subscriber’s identification number
Unique identifier used by your insurance provider
Claims history
Appeals records
Applications and any data contained therein

Do you collect any financial information?

Credit card or debit card number
Card expiration date
Card CVV (security code)
Bank account number

Do you collect any of these types of medical information?

Do you collect any of these types of commercial information?

Records of personal property
Products of services purchased, obtained or considered
Purchasing or consuming histories or tenancies

Do you collect any biometric information?

Imagery of the iris, retina, fingerprint, face, hand, palm, vein patterns or voice recordings
Keystroke patterns or rhythms
Gait patterns or rhythms
Sleep, health or exercise data

Do you collect internet or other electronic activity information?

Browsing history
Search history
Information regarding your interaction with our website or application
Information regarding your interactions with advertisements

Name

This field is for validation purposes and should be left unchanged.