Privacy Rights Request Form

Privacy Rights Request Form

Thank you for contacting Maximus. You may use this form to exercise certain privacy rights that may be available to you. To submit a request to Maximus, please provide all the required information marked with *. If you are making a request on behalf of someone else, please fill out this form and contact us at Privacy@maximus.com and include proof you are authorized to make the request.

Please note we must validate requests submitted before taking further action on them.

Who is this request about (the "Data Subject")*

Select

Who is submitting this request (the "Requestor")*

Select

Requestor email address*

Email address Maximus should use to communicate with the Requestor.

Data Subject First and Last Name*

Data Subject email address provided to Maximus*

Data Subject state of residence*

Select

Business Name provided to Maximus

Business email address provided to Maximus

Business address provided to Maximus

Data Subject's last contact with Maximus

Please provide an approximate date.

Your Request*

Access/Know (specific pieces of personal information)

Access/Know (categories of personal information) (California residents)

Confirmation of processing personal information

Correction

Deletion

Third-Party Disclosures (Oregon residents)

Send me a copy of my responses

Privacy Notice|Report Abuse