Information Collection

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

IC 232923 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction
Scholar Training and Employment Record 1820-0617 RSA PIMS Scholar Training and Employment Record - rev. 11-21-22.docx Form and Instruction
Scholar Training and Employment Record 1820-0617 RSA PIMS Scholar Training and Employment Record - rev. 11-21-22.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

View Information Collection (IC)

IC Title:	Scholars: 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:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Scholar Training and Employment Record	1820-0617 RSA PIMS Scholar Training and Employment Record - rev. 11-21-22.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: 7,628	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	7,628	7,628
Annual IC Time Burden (Hours)	2,411	2,411
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.