Workflows

Request Information

Requester Name

Requester Email

Department

Office

Request Type Value is not selected Press enter to open combobox or type to start search.

Public Records Request

Mechanism Received Value is not selected Press enter to open combobox or type to start search.

Date Request Submitted to State Fund

First Name

Last Name

Business name (if any)

Address

Apt./Suite (if any)

City

State

Zip Code

Phone

Email

Describe the information you are requesting.

Is this information being requested for pending or anticipated litigation in which State Fund may be a party? Value is not selected Press enter to open combobox or type to start search.

Is this request for media purposes? Value is not selected Press enter to open combobox or type to start search.

Privacy Incident

Type of Information

Check all types of personal information that may have been disclosed: Please note: multiple selections can be made as necessary

Name

Address

Social Security Number

Date of Birth (DOB)

Driver's License Number (CDL)

Personal Health Information (PHI)

Personal Financial Information (PFI)

Other

Other Personal Information

Number of persons affected:

Name of Individual(s) affected:

Is this a state agency case? Value is not selected Press enter to open combobox or type to start search.

Name of State Agency, if known

Attach a copy of records sent to the unauthorized recipient (if applicable):

Details of Incident

Claim number or policy number of the affected party (if any):

When did the Incident Occur?

When was the Incident Detected?

Person(s) who may be involved

Department where incident occurred: Value is not selected Press enter to open combobox or type to start search.

Department Location Value is not selected Press enter to open combobox or type to start search.

General Description

Person Reporting a Privacy Incident

I would like to report this... Value is not selected Press enter to open combobox or type to start search.

Name

Email Address

Privacy Question Inquiry

Please explain your question regarding this privacy inquiry

Please attach documents if necessary

Copyright Request

Publication or Material Name

When will materials be used?

How many people will use or see it?

How you plan to use it?

Format you will use Value is not selected Press enter to open combobox or type to start search.

Do you plan to share internally or externally? Value is not selected Press enter to open combobox or type to start search.

Contact information of Copyright Owner (if available)

Do you have a copy of the document you plan to share?

Yes - URL to Uploaded Files

Yes - Documents to Attach now

No

Website link to access copy

Copy of materials you want to use

What to do after filing your request:

Refrain from sharing the material until the Copyright Office provides clearance
If the Copyright Office gives clearance, only share materials as permissions allow
If unsure, ask us!

TC Support (Shared)

Requester Name (External)

Requester Email (External)

Requester Name (Derived)

Requester Email (Derived)

Requester First Name (Internal Only)

Requester Last Name (Internal Only)

Matter Name

Public Records

Current Date

Derived Engagement Date For Public Records

Derived PR First Name

Derived PR Last Name

Privacy Incident

Type of PII

Department Occurred (Drop-down to String for Form Map)

Department Occurred (Contact from TC - set with Form Mapping) Set Involved Business Function

Department Location (Drop-down to String for Form Map)

Department Location (Contact from TC - set with Form Mapping) Set Involved Business Location

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List of failed workflow submissions:

GCP Intake Requests

Request Information

Public Records Request

Privacy Incident

Privacy Question Inquiry

Copyright Request

TC Support (Shared)

Public Records

Privacy Incident