Information Collection

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

IC 232923 under ICR 202603-1820-001 · OMB 1820-0617.

Documents and Forms

Document Name Document Type
NA Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form
NA Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form
NA Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form
NA Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form
NA Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form
NA Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS) Form
Attachment A - RSA PIMS Scholar Training and Employment Record_2.12.26.docx pdp.ed.gov/RSA/ Form
Attachment C - RSA PIMS Employment Verification Record 12.10.25 (1).docx pdp.ed.gov/RSA/ Form
Attachment D - Payback Agreement 12.10.25 (1).docx pdp.ed.gov/RSA/ Form
Attachment E - Exit Certification Form 1 12.10.25 (1).docx pdp.ed.gov/RSA/ Form
Attachment F - Exit Certification Form 2 12.10.25 (1).docx pdp.ed.gov/RSA/ Form
Attachment G - Exit Certification Form 3 12.10.25 (1).docx pdp.ed.gov/RSA/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Scholars: Rehabilitation Services Administration (RSA) Payback Information Management System (PIMS)	Agency IC Tracking Number:

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	NA	NA	Attachment A - RSA PIMS Scholar Training and Employment Record_2.12.26.docx	https://pdp.ed.gov/RSA/	Yes	Yes	Fillable Fileable
Form	NA	NA	Attachment C - RSA PIMS Employment Verification Record 12.10.25 (1).docx	https://pdp.ed.gov/RSA/	Yes	Yes	Fillable Fileable
Form	NA	NA	Attachment D - Payback Agreement 12.10.25 (1).docx	https://pdp.ed.gov/RSA/	Yes	Yes	Fillable Fileable Signable
Form	NA	NA	Attachment E - Exit Certification Form 1 12.10.25 (1).docx	https://pdp.ed.gov/RSA/	Yes	Yes	Fillable Fileable Signable
Form	NA	NA	Attachment F - Exit Certification Form 2 12.10.25 (1).docx	https://pdp.ed.gov/RSA/	Yes	Yes	Fillable Fileable Signable
Form	NA	NA	Attachment G - Exit Certification Form 3 12.10.25 (1).docx	https://pdp.ed.gov/RSA/	Yes	Yes	Fillable Fileable Signable

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: 2,880	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,640	1,012	7,628
Annual IC Time Burden (Hours)	1,443	-968	2,411
Annual IC Cost Burden (Dollars)	36,003	36,003	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.

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