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

Rehabilitation Services Administration (RSA) Payback Information Management System

Documents and Forms

Document Name Document Type
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

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	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 %

	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.