DPI Certificate of Data Destruction

Enter the information below to certify you have destroyed all data received and any personally identifiable information connected with the Data Use Agreement (DUA), either when the DUA expired or when the data was no longer needed for the purposes of the DUA, whichever came first.

Contact Partner Support for any questions about this form.

NOTE! Do not submit any Sensitive Personally Identifiable Information (SPII) through this form. View a list of SPII examples.

First name

Last name

Phone number

Any phone number format will do, but include your area code. For example: 920-555-1212

Email address

DPI DUA Document Control Number

Enter the DPI DUA document control number for the data destruction. The number is found in the footer of your DUA. It has the format "DUA######".

DUA Title

Enter the DUA title to reference the data destruction. If your DUA doesn't have a title enter "No title found."

Data Destruction Comment

List the reports, records and/or file names that will be destroyed and describe the details of the data destruction methods used. This includes data on electronic media and hard copy materials used (i.e. paper). Do not enter any Sensitive Personally Identifiable Information (SPII) in this section.

Planned Data Destruction Date (per DUA)

Enter the planned data destruction date per the DUA.

Actual Data Destruction Date

Enter the date the actual data destruction occurred.

WISE

DPI Certificate of Data Destruction