Name *

First Name

Last Name

Phone number: *

(###)

###

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1. Do you collect consumers’ personal data? *

Personal data may include a name, email address, birthday, payment information, or account number.

Yes

No

2. Which of the following describes your business model? *

(You may select both if you implement aspects of each.)

Business-to-business

Business-to-consumer

3. In which of the following industries is your business involved? *

Financial services (can include loan financing or advising)

Healthcare/medical

Utility sector

Education

Ad exchange or other data-based service

Other

4. Where do customers interact with your business? *

Select all that apply.

Online (check this box if you have a website or app)

In-person (brick-and-mortar stores, markets, etc.)

Via phone (SMS text messaging, marketing calls, customer service, etc.)

Other

5. In which of the following countries do you have customers, employees, or other operations? *

Select all that apply.

United States

United Kingdom (England, Scotland, Wales, Northern Ireland)

European Union (Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden)

Canada

Australia

India

Switzerland

Norway

Other

6. In which of the following states do you control or process the personal data of 25,000 or more consumers? *

California

Colorado

Connecticut

Delaware

Indiana

Iowa

Montana

Nevada

New Hampshire

New Jersey

Oregon

Tennessee

Texas

Utah

Virginia

Other

None of the above

7. In which of the following states do you control or process the personal data of 100,000 or more consumers? *

California

Colorado

Connecticut

Delaware

Indiana

Iowa

Montana

Nevada

New Hampshire

New Jersey

Oregon

Tennessee

Texas

Utah

Virginia

Other

None of the above

8. Do you have employees in California? *

Yes

No

9. Do you sell consumers’ personal information? *

Yes

No

I don't know

10. Do you share consumers’ personal information? *

This can include sharing with service providers or third parties, such as analytics companies that assess performance.

Yes

No

11. Does your business’s annual gross revenue for one calendar year exceed $25,000,000? *

Yes

No

12. Does your business derive 50% or more of its annual revenue from selling consumers’ personal data? *

Yes

No

13. Do you collect any of the following types of sensitive personal information? *

Racial or ethnic origin

Religious beliefs

Mental or physical health condition or diagnosis

Sex life or sexual orientation

Citizenship or citizenship status

Genetic or biometric data that may be processed for the purpose of uniquely identifying an individual

Children’s data

Other

None of the above

14. Do you have, or do you intend to have, social media pages? *

Yes

No

15. Do you have a mobile app? *

Yes

No

16. Do you allow users to create an account or login for the services? *

Yes

No

17. Do you offer automatically-renewing subscription services? *

Yes

No

18. Are users able to make purchases through your services? *

If you use a third-party payment platform, please list it below.

Yes

No

Third-party platform

19. Does your website recognize the Global Privacy Control (GPC)? *

Yes

No

I don’t know

20. Do you solicit and/or publish any of the following user-generated content on your website or social media pages? *

(AKA, do your customers have the chance to upload any of these onto the site?)

Reviews

Photos

Videos

Blog posts

Comments

Other

None of the above

21. Do you utilize any of the following biometric identifiers (of either your employees or customers): *

Facial recognition software

Fingerprints

Avatars

Voice recognition

None of the above

22. Could any of your data collection practices potentially be considered “profiling”? *

Profiling can include any form of automated processing that evaluates, analyzes, or predicts things about a person’s economic situation, health, personal preferences, interests, reliability, behavior, location, or movements.

yes

No

I don't know

23. Do you use, or intend to use, website analytics? *

Check this box if you use cookies.

Yes

No

24. Do you use, or intend to use, targeted advertisements? *

Yes

No

25. Do you have a chat bot or chat feature on your website? *

Yes

No

26. Has your business had any particular security concerns or incidents in the past? *

Yes

No

28. Select any of the following policies/webpages your company currently has: *

Privacy Policy

California Privacy Policy

Terms of Use

Data Subject Access Request (DSAR)

Opt-Out

Employee Privacy Policy

Data Retention Policy

Other IT policies: disaster recovery plan, incident response plan, etc.

None