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OMB Control No.: 60 day FRN open until; Expiration Date: 9/18/2017

US-CERT Incident Reporting System

The US-CERT Incident Reporting System provides a secure web-enabled means of reporting computer security incidents to US-CERT. This system assists analysts in providing timely handling of your security incidents as well as the ability to conduct improved analysis. If you would like to report a computer security incident, please complete the following form. Please provide as much information as you can to answer the following questions to allow US-CERT to understand your incident.
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All fields are optional unless marked * Required

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Malware Submissions

Do not copy and paste malicious code directly into this form. Fill out this incident report in detail. Then, provide the resulting US-CERT Incident ID number in the Open Incident ID field of the Malware Analysis Submission Form where you can submit a file containing the malicious code.
I am:

MY CONTACT INFORMATION

Please provide your contact information so that we are able to contact you should we need to follow-up. Your contact information is not required to submit a report using this form. However, incomplete contact information may limit US-CERT's ability to process or act on your report.

MY ORGANIZATION

DATE AND TIME INFORMATION

When, approximately, did the incident start?
E.g., 02/17/2018
E.g., 06:07 PM
When was this incident detected? * Required
E.g., 02/17/2018
E.g., 06:07 PM

INCIDENT DESCRIPTION

IMPACT DETAILS

Was the confidentiality, integrity, and/or availability of your organization's information systems potentially compromised? * Required

Privacy Act Statement

Authority: 5 U.S.C. § 301 and 44 U.S.C. § 3101 authorize the collection of this information.
Purpose: The primary purpose for the collection of this information is to allow the Department of Homeland Security to contact you about your request.
Routine Uses: The information collected may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using the information as necessary and authorized by the routine uses published in DHS/ALL-002 - Department of Homeland Security (DHS) Mailing and Other Lists System November 25, 2008, 73 FR 71659.
Disclosure: Providing this information is voluntary. However, failure to provide this information will prevent DHS from contacting you in the event there are questions about your request.


Version: 3.0 | Report ID: 2018-USCERTv311YY7Q | Date: 201802171807
Email comments and feedback on the Incident Reporting Form
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