Are there sample notices available for use as a template?

Yes. State agencies should refer to the appendices in the SIMM 5340-C – Requirements to Respond to Incidents Involving a Breach of Personal Information.

• Appendix A – Breach Response and Notification Assessment Checklist (PDF) 
• Appendix C – Sample Breach Notice: Driver’s License or California ID Card Number Only (DOCX)
• Appendix E – Sample Breach Notice: Medical Information Only (DOCX)
• Appendix F – Sample Breach Notice: Health Insurance Information Only (DOCX)