OIT Project ICT Security Review (Form B)

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OIT Project Compliance Review ServiceNow Request Ticket number *

This number will be provided in the email confirmation once the OIT Project Compliance Review Request (Form A) has been received.

Department/Division *

Product/Service Name *

Does your application store or process payments, credit cards, or financial data? *

Yes

Please select all that apply:

Do you store name with credit card payment to University merchant ID? *

Does the software process name with credit card payment to University merchant ID? *

Do you store or process name with ACH payment to University bank account? *

Do you store or process financial account numbers: including university account numbers, student account numbers, and faculty and staff direct deposit account numbers

Does your application store or process patient medical information? *

Yes

Please select all that apply:

Medical records related to an individual (including disability information)

Psychological counseling records related to an individual

Patient demographic or physical characteristics

Health insurance policy ID numbers

Does your application store or process any of the following student data: social security number, national ID, financial aid, loan and bank account numbers, health information, disability, race, ethnicity, citizenship, legal presence, visa information, or religion? *

Yes

Does your application store process any of the following student data: Military status, veteran's status, GPA, probation, suspension, COF, service indicators, all non-directory data not listed, work study information, gender, birth date, dorm, emergency info, student ID, UUID, residency? *

Yes

Does your application store or process other student or academic data (including but not limited to grades, courses taken, transcripts, homework assignment, etc.)? *

Yes

Does your application store or process personally identifiable information? *

Yes

Please check all that apply:

Does your application store or process employee data (including student employee data)? *

Yes

Please check all that apply:

Will University data be stored only in the United States? *

Yes

Will University data be encrypted while in transit? *

Yes

Will University data be encrypted while in storage? *

Yes

How will University data be stored and protected? *

Please be specific, and use examples if needed.

How will University data be deleted or scrubbed? *

Please be specific, and use examples if needed.

How long will University data be stored? *

What encryption methods will be used to protect University data? *

Please be specific, and use examples if needed.

Are you the CU Requestor of this product/service? *

Yes

Does the University have to accept a Terms of Use, User Agreement, or similar document to use or access this product/service? *

Yes

Do users (students, faculty, staff) have to accept a Terms of Use, User Agreement, or similar document to use or access this product/service? *

Yes

If applicable (e.g. 3rd party, external providers, suppliers), please provide a copy of the most recent penetration test results, SSAE 16, or Report of Compliance (ROC). *

Files must be less than 2 MB.
Allowed file types: pdf doc docx xls xlsx zip.

Is there a Privacy Policy in place? *

Yes

Enter the email of your contact at CU Boulder *

Enter an email that should recieve a copy of this form:

(optional)

No further information is needed. Please submit the form by clicking the button below.

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