Form Hud-203 - Lost Label Report Ipia/manufacturer/losing Party printable pdf download

Form Hud-203 - Lost Label Report Ipia/manufacturer/losing Party

Lost Label Report

U.S. Department of Housing and Urban Development

OMB Approval No. 2502-0233

Office of Consumer and Regulatory Affairs

expires 05/31/2003

IPIA/Manufacturer/Losing Party

(Must be completed within 5 days of discovery or loss)

The Manufactured Housing Procedural and Enforcement Regulations 24 CFR Chapter XX Part 3282 Section 552 requires manufacturers to report certification

label usage on a monthly basis. The information collected here will be used to report home distribution, collect fees, and reimburse parties as appropriate

under these Regulations. Public reporting burden for this collection of information is estimated to average 0.5 hours per response including the time for

reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of

information. Response to this information collection is mandatory. This agency may not collect this information, and you are not required to complete this

form, unless it displays a currently valid OMB control number.

Manufacturer’s Name & Address

Factory Address

Manufacturer’s Representative

Phone

Date (mm/dd/yyyy)

Lost Labels

(to be completed by manufacturer or losing party)

Quantity ___________________ certification labels. Date certification label affixed to unit _________________________

(mm/dd/yyyy)

New certification label number affixed to unit ___________________________ Date loss discovered ________________

(mm/dd/yyyy)

Certification label numbers _______________________ through and including _________________________________

Name and address of person who last had possession of certification label(s) when loss was discovered:

Name ___________________________________________________________________________________________

Address _________________________________________________________________________________________

Name and address of person who discovered loss:

Name ___________________________________________________________________________________________

Address _________________________________________________________________________________________

Police or private investigator contacted or used:

Yes

By Whom?__________________________________________________________ Date _________________

(mm/dd/yyyy)

Results (include police or investigator reports):

Why?

Distribution

Original - HUD’s Contracting Agent

Copies to: IPIA

Manufacturer

Previous editions obsolete

Form HUD-203 (1/00)

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Form Hud-203 - Lost Label Report Ipia/manufacturer/losing Party

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