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Payback Agreements and Exit Certifications


Before an award is made to a scholar, grantees must ensure the following assurances are provided (§386.34):

  1. Requirement for agreement. No individual will be provided a scholarship without entering into a written agreement containing the terms and conditions required by this section. An individual will sign and date the agreement prior to the initial disbursement of scholarship funds to the individual for payment of the individual's expenses. An agreement must be executed between the grantee and scholar for each subsequent year that scholarship funds are disbursed and must contain the terms and conditions required by this section.
  2. Disclosure to applicants. The terms and conditions of the agreement between the grantee and a scholar will be fully disclosed in the application for scholarship.
  3. Form and terms of agreement. Prior to granting each year of a scholarship, the grantee will require each scholar to enter into a signed written agreement in which the scholar agrees to the terms and conditions set forth in §386.40. This agreement must be in the form and contain any additional terms and conditions that the Secretary may require.
  4. Executed agreement. The grantee will provide an original signed executed payback agreement upon request to the Secretary.
  5. Standards for satisfactory progress. The grantee will establish, publish, and apply reasonable standards for measuring whether a scholar is maintaining satisfactory progress in the scholar's course of study. The Secretary considers an institution's standards to be reasonable if the standards—
    1. Conform with the standards of satisfactory progress of the nationally recognized accrediting agency that accredits the institution's program of study, if the institution's program of study is accredited by such an agency, and if the agency has those standards;
    2. For a scholar enrolled in an eligible program who is to receive assistance under the Rehabilitation Act, are the same as or stricter than the institution's standards for a student enrolled in the same academic program who is not receiving assistance under the Rehabilitation Act; and
    3. Include the following elements:
      1. Grades, work projects completed, or comparable factors that are measurable against a norm.
      2. A maximum timeframe in which the scholar must complete the scholar's educational objective, degree, or certificate.
      3. Consistent application of standards to all scholars within categories of students; e.g., full-time, part-time, undergraduates, graduate students, and students attending programs established by the institution.
      4. Specific policies defining the effect of course incompletes, withdrawals, repetitions, and noncredit remedial courses on satisfactory progress.
      5. Specific procedures for appeal of a determination that a scholar is not making satisfactory progress and for reinstatement of aid.
  6. Exit certification.
    1. At the time of exit from the program, the grantee will provide the following information to the scholar:
      1. The name of the institution and the number of the Federal grant that provided the scholarship.
      2. The total amount of scholarship assistance received subject to §386.40(a)(7).
      3. The scholar's field of study and the obligation of the scholar to perform the service obligation with employment that meets the requirements in §386.40(a)(7)(i).
      4. The number of years the scholar needs to work to satisfy the work requirements in §386.40(a)(7)(ii).
      5. The time period during which the scholar must satisfy the work requirements in §386.40(a)(8).
      6. As applicable, all other obligations of the scholar in §386.40.
    2. Upon receipt of this information from the grantee, the scholar must provide written and signed certification to the grantee that the information is correct.

According to the Rehabilitation Long Term Training (RLTT) program regulations in 34 CFR §386.34, grantees are required to provide scholars with a Payback Agreement and Exit Certification, which include the terms and conditions of the RLTT Program that the scholars must meet, especially the work obligation. The program regulations further state that the Payback Agreement must be signed and dated by the grantee and scholar prior to the initial disbursement of scholarship funds to the scholar. Similarly, an Exit Certification must be signed and dated by the scholar and the grantee when the scholar exits the program. Both instruments must accurately reflect the terms and conditions, i.e., funding received, the date of exit, and timeline to complete the required service obligation.

To eliminate problems with capturing accurate information or misplacing required payback documents, RSA now requires grantees to use the U.S. Department of Education's OMB-approved (OMB Control Number: 1820-0617; Expiration: 5/31/2026) digital templates for Payback Agreements and Exit Certifications. Grantees and scholars are strongly encouraged to complete the digital Payback Agreement and Exit Certification by logging into PIMS and going to the scholar’s record to initiate the process (see RSA PIMS - Training and Resources ( for information on the digital agreements). As of August 1, 2022 grantees must use the OMB 1820-0617 forms. Grantees and scholars may complete and sign the documents in hard copy and upload the documents in PIMS until August 1, 2022.

Please note: grantees may be responsible for repayment of grant funds in cases where they do not use the required forms or have a signed Payback Agreement or Exit Certification for each scholar.

To initiate developing a hard copy Payback Agreement or Exit Certification, select the link(s) below to access copies of the Payback Agreement and Exit Certification templates.

If you have any questions about the forms please contact the Help Desk at 1-800-832-8142 or

There are three versions of the Exit Certification, based on the scholar’s reason for exiting, as follows 1) the scholar graduates or receives a certificate of completion (Form 1), 2) the scholar voluntarily or involuntarily withdraws from the program (Form 2), and 3) the scholar voluntarily or involuntarily withdraws from the program without completing one academic year of training (Form 3). Only one form should be completed; consequently, please pay careful attention to ensure that you complete the form that appropriately applies to the scholar’s reason for exiting.

Payback Agreement
Exit Certification Form 1
Exit Certification Form 2
Exit Certification Form 3
Payback Agreement (fillable PDF)
Exit Certification Form 1 (fillable PDF)
Exit Certification Form 2 (fillable PDF)
Exit Certification Form 3 (fillable PDF)