Form OS-2001 Private Rental Survey: Trailer Spaces

ATTACHMENT C
Office of the Secretary (OS)
Form 2001

PRIVATE RENTAL SURVEY
TRAILER SPACES

OMB Control Number 1084-0033

City and State:
Name of Trailer Park:
Street Address of Park:
Mailing City and State:

Survey I.D. Number:

Community Code:

Manager or Owner’s Name:

Zip Code:

Manager/Agent Phone:

PARK/SITE DATA (FILL IN APPROPRIATE BLANKS AND CHECK BEST CHOICE)
1. Total Square Feet
(Single-wide sites only)

2. Monthly Contract Rent, single-wides
(Round to the nearest dollar)

3. Year Trailer Park Constructed
4. Trailer Pad Construction:
Hard Surface (cement, asphalt, etc.)

5. Services Paid for by Landlord:
Water (including wells)
Sewer (including septic)
Garbage
Lawn Care
Cable TV
Satellite Dish Hook-up
Electricity
Heating Fuel
Snow Removal

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No
No
No
No
No

Natural Surface (dirt, gravel, etc.)

Paperwork Reduction Act Statement: This information is being used to determine private sector rental rates for trailer
spaces, and will be used to establish rental rates for occupants of government-furnished quarters. Response to this
request is voluntary. No action may be taken against you for refusing to supply the information requested. An agency
may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
current valid Office of Management and Budget (OMB) control number.
Estimated Burden Statement: Public reporting burden for this form is estimated to average 6 minutes per response,
including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form.
Direct comments regarding the burden estimate, or any other aspect of this form, to the U.S. Department of the Interior,
Office of the Secretary, Office of Acquisition and Property Management, 1849 C Street NW, MS 2607-MIB, Washington,
DC 20240.
Privacy Act Statement: Your participation is voluntary. If you do participate, you do not have to give us personal
information in order to complete this form. The data obtained from you will be treated anonymously, and will be used
only for statistical purposes – to measure private rental rates in your community and region. However, we reserve the
right to contact you to clarify this information or to verify our contractor’s performance. We will not disclose this
information; it is published only in aggregate form. We do not give, sell or transfer any personal information to a third
party. It will not be shared with other property managers or rental companies. Direct comments regarding the Privacy
Act, or any other aspect of this form, to the U.S. Department of the Interior, Office of the Secretary, Office of Acquisition
and Property Management, 1849 C Street NW, MS 2607-MIB, Washington, DC 20240.

Completed By:________________________________________________
Printed Name:_________________________________________________
Date:____________________________________
OS-2001