<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 8%" />
<col style="width: 12%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 21%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 1%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="16">Please prepare this sheet for each Information
Collection covered by the ICR.</td>
</tr>
<tr class="even">
<td>1.</td>
<td colspan="6">ICR Title:</td>
<td colspan="7">2. EDICS Tracking Number 3. CFR Citation:</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5">Protection and Advocacy for Assistive Technology (PAAT)
Program Performance Report, Form RSA 661</td>
<td></td>
<td colspan="2">1820-0661</td>
<td></td>
<td>     </td>
<td colspan="2">CFR</td>
<td>     </td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="15"></td>
</tr>
<tr class="odd">
<td>4.</td>
<td colspan="4">Is this a common form? Yes No NA</td>
<td colspan="11"></td>
</tr>
<tr class="even">
<td>5.</td>
<td colspan="4">Information Collection Instruments</td>
<td colspan="11"></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>Instrument Filename</strong></td>
<td><p><strong>Document Type</strong></p>
<p><em><strong>(Select One)</strong></em></p></td>
<td><strong>Form Name and No.</strong></td>
<td colspan="4"><p><strong>Available</strong></p>
<p><strong>Electronically?</strong></p></td>
<td><p><strong>Electronic Capability</strong></p>
<p><em><strong>(Select One)</strong></em></p></td>
<td colspan="3"><p><strong>Obligation to Respond</strong></p>
<p><strong>(select one)</strong></p></td>
<td colspan="3"><p><strong>Affected Public</strong></p>
<p><strong>(check all that apply)</strong></p></td>
<td></td>
</tr>
<tr class="even">
<td rowspan="5"></td>
<td rowspan="5">IC 1661</td>
<td rowspan="5"></td>
<td rowspan="5">Annual Protection and Advocacy for Assistive Technology
Performance Report; Form RSA-661</td>
<td colspan="4"> Yes No</td>
<td></td>
<td colspan="3" rowspan="5"></td>
<td colspan="3" rowspan="5"><p>Federal Government</p>
<p>Individuals or Households</p>
<p>Private Sector</p>
<p>Business or other for-profit</p>
<p>Not-for-profit Institutions</p>
<p>Farms</p>
<p>State, Local or Tribal Gov’t</p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"><p>Can Be Submitted</p>
<p>Electronically?</p></td>
<td>URL:      </td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"> Yes No</td>
<td rowspan="3"><p>Electronic Repository:</p>
<p>     </p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4">Percent Reporting Electronically</td>
<td></td>
</tr>
<tr class="even">
<td colspan="4">100%</td>
<td></td>
</tr>
<tr class="odd">
<td rowspan="5"></td>
<td rowspan="5">IC 2     </td>
<td rowspan="5"></td>
<td rowspan="5">     </td>
<td colspan="4">Yes No</td>
<td></td>
<td colspan="3" rowspan="5"></td>
<td colspan="3" rowspan="5"><p>Federal Government</p>
<p>Individuals or Households</p>
<p>Private Sector</p>
<p>Business or other for-profit</p>
<p>Not-for-profit Institutions</p>
<p>Farms</p>
<p>State, Local or Tribal Gov’t</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"><p>Can Be Submitted</p>
<p>Electronically?</p></td>
<td rowspan="2">URL:      </td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"> Yes No</td>
<td></td>
</tr>
<tr class="even">
<td colspan="4">Percent Reporting Electronically</td>
<td rowspan="2"><p>Electronic Repository:</p>
<p>     </p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4">     %</td>
<td></td>
</tr>
<tr class="even">
<td rowspan="5"></td>
<td rowspan="5">IC 3     </td>
<td rowspan="5"></td>
<td rowspan="5">     </td>
<td colspan="4">Yes No</td>
<td></td>
<td colspan="3" rowspan="5"></td>
<td colspan="3" rowspan="5"><p>Federal Government</p>
<p>Individuals or Households</p>
<p>Private Sector</p>
<p>Business or other for-profit</p>
<p>Not-for-profit Institutions</p>
<p>Farms</p>
<p>State, Local or Tribal Gov’t</p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"><p>Can Be Submitted</p>
<p>Electronically?</p></td>
<td rowspan="2">URL:      </td>
<td></td>
</tr>
<tr class="even">
<td colspan="4"> Yes No</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4">Percent Reporting Electronically</td>
<td rowspan="2"><p>Electronic Repository:</p>
<p>     </p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4">     %</td>
<td></td>
</tr>
</tbody>
</table>

<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 10%" />
<col style="width: 1%" />
<col style="width: 13%" />
<col style="width: 6%" />
<col style="width: 16%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 7%" />
<col style="width: 15%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td>6.</td>
<td colspan="5">Federal Enterprise Architecture Business Reference
Module Line of Business:</td>
<td colspan="9">Subfunction:</td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="5"> Education</td>
<td colspan="9"><p> Elementary, Secondary, and Vocational Education</p>
<p> Higher Education</p>
<p> Cultural and Historic Preservation</p>
<p> Cultural and Historic Exhibition</p>
<p> None</p></td>
<td></td>
</tr>
<tr class="odd">
<td>7.</td>
<td colspan="5">Privacy Act System of Records <em>(if
applicable)</em></td>
<td colspan="9">Federal Register Citation:</td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">Title</td>
<td colspan="3">     </td>
<td></td>
<td>   </td>
<td>FR</td>
<td colspan="2">     </td>
<td colspan="3"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td>8.</td>
<td colspan="14">Respondents:</td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td>a.</td>
<td colspan="2">Number of Respondents:</td>
<td>57</td>
<td></td>
<td colspan="4">b.</td>
<td colspan="2">Number of Respondents who are Small Entities:</td>
<td>57</td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td colspan="4"></td>
<td colspan="9"></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td colspan="4"></td>
<td colspan="9"></td>
<td></td>
</tr>
</tbody>
</table>