Employers: Employment Verification Record

Rehabilitation Services Administration (RSA) Payback Information Management System

Documents and Forms

Document Name Document Type
Employers: Employment Verification Record Form and Instruction
Employment Verification Record RSA PIMS Employment Verification Record ICR Package 1820-0617 (final).docx Form and Instruction
Employment Verification Record RSA PIMS Employment Verification Record ICR Package 1820-0617 (final).docx Form and Instruction

Information Collection (IC) Details

IC Title:	Employers: Employment Verification Record	Agency IC Tracking Number:	ED-2018-ICCD-0094

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	Employment Verification Record	RSA PIMS Employment Verification Record ICR Package 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: 3,600	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,600	0	3,600
Annual IC Time Burden (Hours)	601	-11	612
Annual IC Cost Burden (Dollars)	0	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.