Form Hud-304 - Adjustment Report - Monthly Production Report Template - U.s. Department Of Housing And Urban Development
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1U.S. Department of Housing and Urban Development
OMB Approval No. 2502-0233
Adjustment Report
Office of Consumer and Regulatory Affairs
expires 05/31/2003
Monthly Production Report
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)
Report for month of (mm/yyyy)
IPIA
Section I
(to add an unreported unit)
Certification
Type of
Date of
First shipping destination information
Manufacturer’s M/H
Unit
Label Number
Zip
Manufacture
(*see
ID or Serial Numbers
(include all zeros
Dealer’s Name
City
Code
(mm/dd/yyyy)
State
below)
and agency prefix)
Section II
(to correct previously reported information)
Certification
Type
Date of
Manufacturer’s M/H
Label Number
of Unit
Manufacture
Previous information
Correction
ID or Serial Numbers
(include all zeros and
(*see
(mm/dd/yyyy)
agency prefix)
below)
Section III
(to be completed for open destinations)
Certification
Type
Date of
First shipping destination information
Manufacturer’s M/H
Label Number
of Unit
Manufacture
Zip
ID or Serial Numbers
(*see
(include all zeros
Dealer’s Name
City
State
(mm/dd/yyyy)
Code
below)
and agency prefix)
*Type of Unit:
Distribution
Single-wide Unit (S)
Original - HUD’s Contracting Agent
Multi-wide Unit 1st Section (M1)
Copies to: IPIA
Multi-wide Unit 2nd Section (M2)
Manufacturer
Multi-wide Unit 3rd Section (M3)
Previous editions obsolete
Form HUD-304 (1/00)
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