Information Collection Request

Rehabilitation Services Administration (RSA) Payback Information Management System

ICR 202505-1820-005 · OMB 1820-0617 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) State Vocational Rehabilitation (VR) Agency Job Board Posting Form and Instruction Unchanged Available
Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form and Instruction Unchanged Repair queued
Employment Verification Record Form and Instruction Unchanged Available
Employers: Employment Verification Record Form and Instruction Unchanged Repair queued
RSA Exit Certificate Form and Instruction Unchanged Available
RSA Payback Agreement Form and Instruction Unchanged Available
Scholar Training and Employment Record Form and Instruction Unchanged Available
Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction Unchanged Repair queued
RSA Exit Certificate Form and Instruction Modified Available
RSA Payback Agreement Form and Instruction Modified Available
Grantee Scholar Record Form and Instruction Modified Available
Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction Modified Repair queued
OMB-OSERS-ICR-Non-substantive_group-request (05.09.2025).docx Justification for No Material/Nonsubstantive Change Uploaded 2025-05-16 Available
OMB-OSERS-ICR-Non-substantive_group-request (05.09.2025).docx Justification for No Material/Nonsubstantive Change Uploaded 2025-05-16 Repair queued
RSA PIMS Scholar Record 1820-0617 Redline.docx Supplementary Document Uploaded 2025-05-16 Available
RSA PIMS Scholar Record 1820-0617 Redline.docx Supplementary Document Uploaded 2025-05-16 Repair queued
1820-0617 Supporting Statement (final)_4.5.23.docx Supporting Statement A Uploaded 2023-04-06 Available
1820-0617 Supporting Statement (final)_4.5.23.docx Supporting Statement A Uploaded 2023-04-06 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
257788 Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form and Instruction UnchangedRehabilitation Services Administration (RSA) Payback Information Management System (PIMS) State Vocational Rehabilitation (VR) Agency Job Board Posting
257788 Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form and Instruction Unchanged
232924 Employers: Employment Verification Record Form and Instruction UnchangedEmployment Verification Record
232924 Employers: Employment Verification Record Form and Instruction Unchanged
232923 Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction UnchangedRSA Exit Certificate
232923 Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction UnchangedRSA Payback Agreement
232923 Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction UnchangedScholar Training and Employment Record
232923 Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction Unchanged
190462 Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction ModifiedRSA Exit Certificate
190462 Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction ModifiedRSA Payback Agreement
190462 Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction ModifiedGrantee Scholar Record
190462 Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2026 05/31/2026 05/31/2026
12,026 0 12,026
4,906 0 4,906
0 0 0





Reginfo record details
4
table that charts list of burden
IC Title Form No. Form Name
Employers: Employment Verification Record NA
Grantees: Rehabilitation Services Administration (RSA) Payback Information Management System NA, NA, NA ,   ,  
Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) N/A
Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System NA, NA, NA ,   ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 12,026 12,026 0 0 0 0
Annual Time Burden (Hours) 4,906 4,906 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No