RSA Annual Payback Report

Grantee Reporting Form -Rehabilitation Services Administration (RSA) Annual Payback Report

⚠️ Notice: This information collection may be referencing outdated material.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
1820-0617 (04877) RSA Payback MIS manual.doc Instruction
RSA Annual Payback Report (Screenshots) 1820-0617 (04877) RSA Annual Payback Report Screenshots.docx Form

Information Collection (IC) Details

IC Title:	RSA Annual Payback Report	Agency IC Tracking Number:	04877

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
Instruction			1820-0617 (04877) RSA Payback MIS manual.doc		Yes	Yes	Fillable Fileable
Form	N/A	RSA Annual Payback Report (Screenshots)	1820-0617 (04877) RSA Annual Payback Report Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 350	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	350	0	350
Annual IC Time Burden (Hours)	350	-50	400
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.