CNMI PSS Data Destruction Assurance Form

CNMI PSS Data Destruction Assurance Form
Name of Authorized Designee to Complete Data Destruction Process Include School Program or Department Name:*
Email for Authorized Designee:*
example@example.com
Itemized inventory of data / records that will be destroyed:*
Method of Data Destruction:*

Data wiping (Digital)Degaussing (Digital)Cross-cut shredding (Physical)Incineration (Digital/Physical)Milling (Physical)Pulping Purge (Physical)Other Approved Method
Data Destruction Completed:*

MonthDayYear
Cannot be a future date
Assurance & Certification: The aforementioned data has reached the designated retention period and may be destroyed. The responsibility for ensuring this destruction lies with the designated authorized data user, regardless of any third-party designated data destroyer.
Authorized Designee:*
Signature:*

Clear
Date:*

MonthDayYear
Date
Should be Empty: