Data Subject Access Request Form

Data Subject Access Request Form Template for United States

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1. Select your governing law and document type:

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Key Requirements PROMPT example:

"I need a Data Subject Access Request Form for my healthcare technology company that complies with both HIPAA and CCPA requirements, with specific sections for medical data categories and third-party data sharing disclosures."

Document background

The Data Subject Access Request Form has become increasingly important with the evolution of data privacy laws in the United States, particularly with the implementation of the CCPA/CPRA and similar state laws. This document serves as a formal mechanism for individuals to exercise their legal right to understand what personal information organizations hold about them, how it's being used, and who it's being shared with. It helps organizations maintain compliance with privacy regulations while providing a clear, structured process for handling data access requests.

Suggested Sections

1. Data Subject Information: Personal details of the individual making the request including name, contact information, and any reference numbers

2. Request Details: Specific information about what personal data is being requested and the preferred format of response

3. Identity Verification: Methods and requirements for verifying the requestor's identity to ensure data security

4. Timeline Acknowledgment: Statement about response timeframes and legal obligations for processing the request

5. Declaration: Confirmation of truthfulness of information provided and signature section

Optional Sections

1. Authorization Section: Required only when someone is making a request on behalf of another person, including proof of authority

2. Specific Data Categories: Optional section for requesting specific types of data (e.g., medical, financial, educational records)

3. Date Range Specification: Optional section for specifying a particular time period for the requested data

Suggested Schedules

1. Identity Verification Documents: List of acceptable identity verification documents and requirements

2. Fee Schedule: Details of any applicable fees for processing the request and payment methods

3. Privacy Notice: Information about how the personal data provided in the form will be processed and protected

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Personal Data

Personal Information

Clauses

Relevant Industries

Healthcare
Financial Services
Technology
Retail
Education

Relevant Teams

Legal
Privacy
Compliance
Information Security
Customer Service

Relevant Roles

Privacy Officer
Data Protection Officer
Compliance Manager
Legal Counsel
Information Security Manager

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Data Subject Access Request Form Template for United States

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