# INFORMATION COLLECTION SUBMISSION WORKSHEET

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## 1 Please read the instructions before completing this form. For assistance in completing this form, contact your Information Clearance Coordinator or your ICCD analyst Submit electronic copies of this form, the collection instrument (s) to be reviewed, parts A and B of the supporting statement, and any additional documentation through EDICS. 1. Agency/Subagency Originating Request: U.S. Department of Education/ Office of Special Education and Rehabilitative Services (OSERS)/ Rehabilitation Services Administra tion (RSA) 2. EDICS Tracking and OMB Control Number: 1820 - 0528 3. Title: Client Assistance Program (CAP) 4. Type Of Information Collection (Check One): New collection Revision of a cur rently approved collection Extension of a currently approved collection Reinstatement, with change of a previously approved collection Reinstatement, with out change of a previously approved collection Existing collection in use without an OMB control number 4a. Is this a request for a generic clearance? **Yes No**  **NA** 4b. Is this a common form? **Yes No**  **NA** 5. Type Of Review Requested: Regular (If Streamlined Also Click Here ) Emergency – Approval requested by: MM/DD/YYYY 6. Expiration Date: MM/DD/YYYY a. Three Years From Approval Date b. Six months from approval date (Max for Emergency Review) c. Other: MM/DD/YYYY d. Specify: / or Number of Months from Approval Date: 7. Does this ICR contain surveys, censuses, or employ statistical methods? Yes (Attach Part B of Supporting Statement) No 8. Does the Supporting Statement serve as a Joint ICR and Privacy Impact Assessment per OMB Memorandum 03 - 22 Section IID ( http://www.whitehouse.gov/omb/memoranda/m03 - 22.html ) ? Yes No NA 9. Agency Conta ct and Phone Number: Jim Doyle (202) 245 - 6630 10. Abstract: Form RSA 227 is used to meet specific data collection requirements contained in Section 112 of the Rehabilitation Act of 1973 , as amended, and its implementing Federal Regulations at 34 CFR Part 370. Data from the form have been used to evaluate individual programs. These data also have been used to indicate trends in the provision of services from year-to -year. Form RSA - 227 has enabled RSA to furnish the President and Congress with data on the p rovision of advocacy services and has helped to establish a sound basis for fut ure funding requests.
11. Authorizing Statute(s):

a. US Code 29 USC 732(a) Name of Law: Client Assistance Program US Code USC Name of Law: b. PL Pub L 10 5 220 Sec 112 Name of Law: Client Assistance Program PL Pub.L. - Sec Name of Law:

c. Statute at Large USC Name of Statute: Statute at Large USC Name of Statute: d. EO EO Name /Subject of EO: EO EO Name/Subject of EO:

e. CFR 34 Section (s) 12. Associated Rulemaking Information

RIN: Stage of Rulemaking (check one):

 Proposed Rule Interim Final or Final Rule Not associated with rulemaking For a Proposed Rule, OMB will not consider an ICR complete until the Notice of Proposed Rulemaking has been published.

# INFORMATION COLLECTION SUBMISSION WORKSHEET

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## 2 1 3 . Annual Cost to the Federal Government: $ 4, 116 .00 1 4 . Annual reporting and recordkeeping hour burden: a. Number of respondents: 56 Nu mber of Respondents who are Smal l Entities: 0 b. Total annual responses: 5 6

Percentage of these responses collected electronically: 100 % c. Total annual hours requested: 896 d. Current OMB inventory: 896 e. Differenc e (+/- ): 0 f. Explanation of difference

1. Program Change 2. Adjustment:
1 5 . Citations for New Statutory Requirements: (Required if any change in burden is a Program Change Due to New Statute.)

a. US Cod e: USC Name of Law: b. PL: Pub.L. - Sec Name of Law:

c. Statute at Large: USC Name of Statute: d. EO: EO Name /Subject of EO: 1 6 . Burden increases because of Program Change due to Agency Discretion Burden decreases because of Program Change due to Agency Discretion Burden increases because of program change due to statutory changes Burden decreases because of program change due to statutory changes Burden increases because of program change due to lapse of OMB approval Burden decreases because of program change due to lapse of OMB approval Shor t Statement: (Explain the reasons for any program changes or adjustments reported; provide a short statement on how the reduction in burden was achieved or why the increase in burden occurred. (if you need more space, please provide a short stat ement less than 4000 characters here and elaborate in the supporting statement.))

1 7 . Complete ONLY if this collection requests racial and ethnic data: A. Please check the correct box: This collection requests racial and ethnic data from individuals . This collection requests racial and ethnic data from an aggregated level. B . Is this collection compliant with the October 2007 Final Guidance on Maintaining, Collecting, and Reporting Racial and Ethnic Data? Yes No C. If no, provide the PO schedule for be coming compliant for 2010 Fall Enrollment data : (date)

# INFORMATION COLLECTION SUBMISSION WORKSHEET

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## 3 1 8 . Is this collection related to EDFacts? Yes No NA 19 . Are EDFacts standard definitions for School, LEA, SEA, Children With Disabilities, LEP and Migrant Used? Yes No NA 2 0 . Please describe the types of reports and analysis to be performed against the data (500 Characters Maximum): Form RSA - 227 will be used to analyze and evaluate the Client Assistance Program (CAP) administered by designated CAP agencies. These agencies provide information, advocacy, and legal services to individuals seeking or rec eiving services from programs and projects authorized by the Rehabilitation Act of 1973, as amended , in order to resolve disputes . Data also are reported on information and referral services provided to any individual with a disability. 2 1 . Federal Enter prise Architecture Business Reference Module Line of Business: Subfunction:

Education Elementary, Secondary and Vocational Education Higher Education None 2 2 . Privacy Act Systems of Records Notice (if applicable): Title:_______________________

_____________________________________________ Citation: Vol.________ FR ___________________ Citation Date: _____________________________