Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System

Grantee Reporting Form -Rehabilitation Services Administration (RSA) Annual Payback Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1820-0617 can be found here:

Documents and Forms

Document Name Document Type
Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction
Grantee Scholar Record RSA PIMS Grantee Scholar Record ICR Package 1820-0617 (final).docx Form and Instruction
Grantee Scholar Record RSA PIMS Grantee Scholar Record ICR Package 1820-0617 (final).docx Form and Instruction
RSA Payback Agreement Payback Agreement 1820-0617 (final).docx Form and Instruction
RSA Payback Agreement Payback Agreement 1820-0617 (final).docx Form and Instruction
RSA Exit Certificate RSA Exit Certification form 1820-0617 (final).docx Form and Instruction
RSA Exit Certificate RSA Exit Certification form 1820-0617 (final).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System	Agency IC Tracking Number:	ED-2018-ICCD-0094

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 386.33-386.35 34 CFR 386.40-386.43

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Grantee Scholar Record	RSA PIMS Grantee Scholar Record ICR Package 1820-0617 (final).docx	PIMS	Yes	Yes	Fillable Fileable
Form and Instruction	NA	RSA Payback Agreement	Payback Agreement 1820-0617 (final).docx	PIMS	Yes	Yes	Fillable Fileable
Form and Instruction	NA	RSA Exit Certificate	RSA Exit Certification form 1820-0617 (final).docx	PIMS	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title: Privacy Act of 1974; System of Records	FR Citation: 84 FR 32889

Number of Respondents: 562	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	562	562
Annual IC Time Burden (Hours)	1,835	1,835
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.