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privacy risk assessment - short form — confidential - International ...

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WHO IS THE DATA ABOUT<br />

(Place an X in each box that applies for every data element in scope of the project)<br />

Sensitive In<strong>form</strong>ation<br />

Company<br />

Employee,<br />

Temporary<br />

Worker, or<br />

dependents<br />

Corporate<br />

Contact<br />

(e.g., John<br />

Smith, X<br />

Corp)<br />

Employee,<br />

Temporary<br />

Worker<br />

Client<br />

Consumer<br />

Patient<br />

Customer<br />

Dependents<br />

Other<br />

(describe<br />

in the<br />

Comments<br />

field)<br />

Comments<br />

(if applicable)<br />

Social Security Numbers (SSN-U.S.)<br />

Other Government Issued ID Numbers<br />

Banking / Financial Info / Account History<br />

Credit Card, Debit Card + PIN, and Banking<br />

In<strong>form</strong>ation<br />

Visa or Passport Numbers<br />

Driver's License<br />

In<strong>form</strong>ation relating to race or ethnic origin,<br />

religious beliefs, health, political opinions, sexual<br />

orientation or criminal record. Please detail what<br />

is collected.<br />

National or Health Insurance Numbers<br />

…Medical History<br />

…Medical Claims<br />

…Medical Insurance Numbers<br />

Page 8 of 8

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