HUD Manufactured Home Retailer Report –
U.S. Department of Housing and Urban Development
OMB Approval No. 2502-0578
Home Installation Information
Office of Manufactured Housing Programs
Expires 04/30/2018
The Manufactured Housing Installation Program Regulations 24 CFR Chapter XX Part 3286 Section 113 requires manufactured home retailers and distributors to report specific information about the
installation of a new manufactured home within 30 days from the date of installation. The information collected here will be used in conjunction with manufacturer shipment reports, retail information
reports, and other reports as appropriate under these Regulations. Public reporting burden for this collection is estimated to average 0.25 hour per response including the time for reviewing the
instructions, searching existing data sources, gathering and maintaining the data as needed, and completing and reviewing the collection of information. Response to the information collection is
mandatory. This agency may not collect this information, and you are not required to complete this form, unless the form displays a currently valid OMB control number.
Retailer/Distributor Name & Address
Date (mm/dd/yyyy)
Retailer/Distributor Representative (signature)
Check box if report is for correcting previously reported information
Reporting Period:
(mm/dd/yyyy) __________________ through (mm/dd/yyyy) ___________________
Page _____ of _____
Installation Information
Installation Inspection Information
Manufacturer’s
Certification
Date
Serial Number
Date of
Inspector
Installer’s
Label Number
Installation
Installer’s
(Including all letters
Installer Name, Address & Phone Number
Inspector Name, Address & Phone Number
Verification
HUD License
(include all zeros and
Work
and numbers)
Certification
Date
agency prefix)
Number
Began
(mm/dd/yyyy)
(mm/dd/yyyy)
(mm/dd/yyyy
Distribution:
HUD
Retailer
Form HUD-306