HUD-304 Adjustment Report

Adjustment Report
Monthly Production Report

U.S. Department of Housing and Urban Development
Office of Manufactured Housing Programs

OMB Approval No. 2502-0233
expires 01/31/2013

The Manufactured Housing Procedural and Enforcement Regulations 24 CFR Part 3282 Section 501 authorizes the Secretary to take such actions to oversee
the system as the Secretary deems appropriate. This from requires the manufacturer to report any adjustments to previously submitted monthly production
reports. The information collected here will be used to request certification labels from the Secretary and confirm the receipt of the certification labels as
required 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 instr uctions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Response to this information collection is mandator y under 42 U.S.C 5413(c)(3). 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 Name & Address

Manufacturer’s Representative

Phone

Report for month of (mm/yyyy)

IPIA

Date (mm/dd/yyyy)

Section I (to add an unreported unit)
Certification
Label Number
(include all zeros
and agency prefix)

Manufacturer’s M/H
ID or Serial Numbers

Date of
Manufacture
(mm/dd/yyyy)

First shipping destination information
Dealer’s Name

City

State

Zip
Code

Type of
Unit
(*see
below)

Section II (to correct previously reported information)
Certification
Label Number
(include all zeros and
agency prefix)

Date of
Manufacturer’s M/H
ID or Serial Numbers Manufacture

Previous information

Type
of Unit
(*see
below)

Correction

(mm/dd/yyyy)

Section III (to be completed for open destinations)
Certification
Label Number
(include all zeros
and agency prefix)

Date of
Manufacturer’s M/H
ID or Serial Numbers Manufacture

Distribution
Original - HUD’s Contracting Agent
Copies to: IPIA
Manufacturer
Previous editions obsolete

(mm/dd/yyyy)

First shipping destination information
Dealer’s Name

City

State

Zip
Code

Type
of Unit
(*see
below)

*Type of Unit:
Single-wide Unit (S)
Multi-wide Unit 1st Section (M1)
Multi-wide Unit 2nd Section (M2)
Multi-wide Unit 3rd Section (M3)
Form HUD-304 (06/09)