Information Collection

Case Service Report (RSA-911)

IC 186855 under ICR 202012-1820-001 · OMB 1820-0508.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1820-0508 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 911 Case Service Report (RSA-911)	Form and Instruction
911 Reporting Tool for the Case Service Report (RSA-911) Copy of Case Service Report (RSA-911 12.03.2020) - FINAL.xlsx	Form and Instruction
911 Reporting Tool for the Case Service Report (RSA-911) Copy of Case Service Report (RSA-911 12.03.2020) - FINAL.xlsx	Form and Instruction

IC Title:

Case Service Report (RSA-911)

Agency IC Tracking Number:

ED-2018-ICCD-0100

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 361

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	911	Reporting Tool for the Case Service Report (RSA-911)	Copy of Case Service Report (RSA-911 12.03.2020) - FINAL.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title: RSA-911 Case Service Report

FR Citation: 85 FR 46075

Number of Respondents: 78

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	312	234	78
Annual IC Time Burden (Hours)	34,446	0	34,446
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.