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Confidential Information-Data Transmission Report
 

This form is used to allow a department or individual to document student, staff, or faculty confidential information stored requiring access and transmission offsite (i.e. to storage devices not maintained by U.I.S.) electronically at Shawnee State University.  Shawnee State offers a comprehensive definition of student, staff, or faculty information residing on university or personally-owned storage devices that is considered confidential in nature, in the UTAC-approved Conditions for Confidential Information document.

Information submitted on this form will be forwarded to the Director of UIS for the purpose of  evaluating the secure transmission method and forwarded to a V.P. or appropriate designee for approval.  It may also be shared with other SSU employees charged with the task of identifying SSU and its contractor's responsibility for providing a protocol to protect confidential data.

Submitting the requested information below for each file or database you or your department creates which is comprised of confidential information transmitted off-site, will ensure it is included in the scope of secure transmittal.
Point of Contact (POC) information
Name:  Job Title:  Dept: 
Work Phone:  Email:   
Report Date:      Time:  
Frequency of Transmission: 
Purpose of Transmission: 
Description of Transmission: 
Description of Confidential Information: 
Name of File:   
Location of File:  
(BE SPECIFIC.  For example, your PC or laptop's hard drive (include path (ex. C:\Document and Settings\...), file cabinet, etc) 
Other Locations of File or Other Format of File:  (ex. your PC's hard drive, CD backup, additional paper copy etc) 
Is the Data Currently Transmitted Electronically Offsite, or is it a Proposed Transmittal:   Current   Proposed   Unknown
Offsite Transmittal Destination:  
Offsite Transmittal Method:   Dialup Modem FTP Internet Based  Email
Electronic Data Format:   Spreadsheet  Database  Word Document  Email  Other
Electronic Media Format:  CD/DVD  Hard Drive    Floppy  External Storage Device  USB Drive  Mobile Storage Device    Tape    Disk
Data Accessibility:  Encrypted Unencrypted Redacted  Unredacted Unknown
Security Protocol used for Transmission: HTTPS   SFTP (Secure ftp)  Secure Email  SSL  PKI  Unknown   Other (specify)
   
Is Shared Access to Data Currently Possible: Yes   No   Unknown
Other Individuals Currently Accessing Data: