Balance Autism Data Breach Class Action Settlement

What the form asks

• — The claim number printed on the postcard notice you received from Balance Autism (On the postcard notice mailed to you by the settlement administrator)
• — The PIN printed on the postcard notice you received (On the postcard notice alongside your claim number)
• — Select one benefit tier: credit monitoring, alternative cash payment, ordinary loss, lost time, or extraordinary loss (Your own records of out-of-pocket expenses or time spent responding to the breach)
• — A written description of the activities you performed and the time you spent responding to the data incident (Your own recollection of steps taken — credit freeze calls, fraud alerts, monitoring setup, etc.)

Documents you'll need

Watch out for

• The alternative cash payment cannot be combined with ordinary loss, lost-time, or extraordinary loss reimbursements — choosing the flat payment excludes the other monetary benefits
• Lost-time reimbursement is only available if you spent at least one full hour responding to the data incident; partial hours below one hour are not eligible
• Extraordinary loss documentation cannot be self-prepared — it must come from a third party
• If total valid monetary claims exceed the fund cap, individual payments will be reduced proportionally
• You must attest to lost-time claims under penalty of perjury