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THE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF PUBLIC SAFETY AND SECURITY Department of Criminal Justice Information Services 200 Arlington Street, Suite 2200, Chelsea, MA 02150 TEL: 6176604600
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Start by carefully reading the instructions provided for filling out the form.
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Provide accurate and truthful information regarding the incident or situation that involves improper access andor dissemination.
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Clearly state the details of the incident, including when and where it occurred, who was involved, and any relevant evidence or documentation.
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Who needs improper access andor dissemination?

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Individuals or organizations involved in incidents of improper access andor dissemination of sensitive or confidential information may need to fill out forms related to this issue.
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This may include employees who have accessed or disseminated information without proper authorization, individuals accused of hacking or unauthorized access to systems, or anyone involved in the unauthorized sharing or distribution of confidential materials.
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Additionally, individuals or organizations that have been victims of improper access andor dissemination may be required to report the incident and provide information through specific forms or procedures.
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Improper access and/or dissemination is the unauthorized or inappropriate access to or sharing of sensitive information.
Any individual or organization that has experienced or been made aware of improper access and/or dissemination of sensitive information is required to file a report.
The report should include details of the incident, such as when and how it occurred, what information was accessed or disseminated, and any actions taken in response.
The purpose is to ensure that incidents of unauthorized access or sharing of sensitive information are properly documented and addressed to prevent further breaches.
The report should include details of the incident, including the date, time, and manner of access or dissemination, the type of information involved, and any actions taken in response.
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