Are there payment card transactions? *

Yes

No

If 'Yes', is the applicant PCI compliant? *

Yes

No

N/A - Client does not accept payment cards

Does the applicant deal with Protected Health Information (PHI)? *

Yes

No

If 'Yes', is the client compliant with HIPAA and HITECH? *

Yes

No

N/A - client does not deal with PHI

Please check all of the following that are in place: *

Antivirus and Firewalls

Encryption of Sensitive Data

Encryption of Mobile Computing Devices

Critical Software Patching Procedures

Critical Data Backup and Recovery Procedures

Formal Cyber Incident Response Plan

None of these are in place