Form C-MH-9A Survey of New Manufactured (Mobile) Home Placements

Attachment 3
OMB No. 2528-0029: Approval Expires 12-31-2009

C-MH-9A

FORM
(8-25-2009)

U.S. DEPARTMENT OF COMMERCE
Economic and Statistics Administration

NOTICE — Your report to the Census Bureau is confidential by law (Title 13, U.S. Code).
It may be seen only by persons sworn to uphold the confidentiality of Census Bureau
information and may be used only for statistical purposes. The law also provides that copies
retained in your files are immune from legal process.

U.S. CENSUS BUREAU
ACTING AS COLLECTION AGENT FOR

U.S. DEPARTMENT OF HOUSING
AND URBAN DEVELOPMENT

SURVEY OF NEW
MANUFACTURED
(MOBILE) HOME
PLACEMENTS
RETAIN THIS FORM FOR YOUR FILES
(Please correct any error in name, address, and ZIP Code)

NOTE

At the request of the U.S. Department of Housing and Urban Development, the U.S. Census
Bureau is conducting this survey. The Census Bureau will release and publish only statistical
aggregates, which do not reveal the operations of individual dealers. Copies of the published
results will be available on request.

FROM THE DIRECTOR
U.S. CENSUS BUREAU
The Census Bureau requests your participation in the survey of new manufactured
homes, conducted for the Department of Housing and Urban Development. For the
manufactured (mobile) home identified in Section I on the back of this form, please
complete sections II through IV. Manufacturers, suppliers, developers, and lenders use
the results from this voluntary survey to make more informed decisions concerning
industry production, investment, and financing.
We will contact you to obtain your information within a few days. If you prefer, you may
fax the form to us toll-free at 1–800–274–0761 or mail the form to us in the enclosed
postage-paid return envelope. If you choose to mail or fax the form, please remember to
retain a copy of this form for your records, since we will continue to follow up on this
manufactured home until it is permanently placed.
We recognize that providing this information is a burden. To help minimize the burden,
we request information for only a sample of homes shipped by manufacturers and
provide the option of a toll-free response. The law that authorizes this survey (Title 13,
United States Code) requires that we keep your report strictly confidential. We will
release and publish only statistical aggregates, which do not reveal the operations of
individual dealers.
If you have any questions, please contact my staff on 1–800–845–8249. Thank you in
advance for your cooperation.
Sincerely,

Robert M. Groves
Enclosure

We estimate that it will take from 20 to 40 minutes to complete this questionnaire and provide answers to our
representative when called, with 30 minutes being the average time. If you have any comments regarding
these estimates or any other aspect of this survey, including suggestions for reducing the burden, send them
to: Paperwork Project 0607-XXXX, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC
20233. You may e-mail comments to Paperwork@census.gov; use "Paperwork Project 0607-XXXX" as the
subject. This agency may not collect this information, and you are not required to complete this form, unless it
displays a current valid Office of Management and Budget control number.

AFTER COMPLETING THE REVERSE SIDE, PLEASE FAX,
MAIL OR RETAIN THIS FORM FOR A TELEPHONE INTERVIEW.
USCENSUSBUREAU

Attachment 3

Section I – IDENTIFICATION OF MANUFACTURED (MOBILE) HOME
Label identification information
Line 1 – Name of manufacturer
Line 2 – Manufacturer’s serial number
(first section only)
Line 3 – HUD inspection number
(first section only)
Line 4 – Type of home

Section II – CURRENT STATUS OF MANUFACTURED (MOBILE) HOME
1. In what month and year was the home described above received from the manufacturer?
(If this home has not been received, please provide the reason in the "Remarks" section
and do not complete the remainder of the questions.)

Month

Year

2. What is the current status of the home?
1
On any of your lots and not placed (whether sold or not) – Please complete section IV
2

3

Placed on a site for RESIDENTIAL USE – Enter month and
year placed
Placed on a site for nonresidential use – Enter month and
year placed

4

Returned to manufacturer – Enter month and year returned

5

Shipped to another sales location – Enter month and
year shipped

Month

Year

Month

Year

Month

Year

Month

Year

– Please complete
sections III and IV

⎫ Do not complete
⎬ sections III and IV
⎭– Please complete
below

⎫
⎬
⎭

Name of sales location
Number and street name – Box and route number
State

City, town, village, etc.

6

Telephone
Area Code Number

ZIP Code

Do not
complete
sections
III and IV

Boxes 1–5 do not apply – Please explain in the "Remarks" section

Section III – PLACEMENT INFORMATION ON MANUFACTURED (MOBILE) HOME
1. Was this home sold, placed for sale, or leased?
1

Sold – What was the sales price?
(Include options and dealer setup.
Exclude all taxes and land costs.)

2. How is this
home titled?

1
2

3. At what location was
this home placed?

As real estate (property)
As personal property

Placed for sale
Leased

2

$

.00
3

3

Home is registered (licensed)
and NOT titled

Number and street name – Box and route number – Space and park name
City, town, village, etc.
State

County

4. Is this location
1
2
3

5. Was this home
placed on

1

2

6. How is this home
secured in place?

1
2
3

ZIP Code

In a park or court?
In a subdivision or planned unit development?
NOT in any of the above?
A permanent masonry foundation?
– Skip to section IV
A concrete pad?

3
4

Blocks but not on a concrete pad?
Some other way? –
Please explain in the "Remarks" section

Secured by tie-down straps
Secured by some other means – Explain in "Remarks"
NOT secured

Section IV – CHARACTERISTICS OF MANUFACTURED (MOBILE) HOME
Feet

1. What is the length of this home?
Feet

2. What is the width, including all sections?
Number

3. How many bedrooms are in this home?
4. Does this home have central air-conditioning?
Remarks

1

Yes

2

PLEASE RETAIN A COPY OF THIS FORM IF YOU CHOOSE TO MAIL OR FAX
FORM C-MH-9A (8-25-2009)

No