Information Collection

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

IC 190462 under ICR 202301-1820-001 · OMB 1820-0617.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System	Form and Instruction
Grantee Scholar Record Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System	Form and Instruction
RSA Payback Agreement Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System	Form and Instruction
RSA Exit Certificate Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System	Form and Instruction
Grantee Scholar Record 1820-0617 RSA PIMS Scholar Record revised 20230329.docx	Form and Instruction
Grantee Scholar Record 1820-0617 RSA PIMS Scholar Record revised 20230329.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

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:

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	NA	Grantee Scholar Record	1820-0617 RSA PIMS Scholar Record revised 20230329.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 %

table that charts list of burden
	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

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.