HUD-305 HUD Manufactured Home Retailer Report -Home Installation

HUD Manufactured Home Retailer Report – Home Tracking Information

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

OMB Approval No. xxxx-xxxx Expires mm/dd/yyyy

The Manufactured Housing Installation Program Regulations 24 CFR Chapter XX Part 3286 Section 113 requires manufactured home retailers and distributors to report specific information within 30 days from the time a purchaser enters into a contract to purchase a manufactured home when the manufactured home will be sited in a state that HUD administers the installation program. The information collected here will be used in conjunction with manufacturer production reports and other reports as appropriate under these Regulations. Public reporting burden for this collection is estimated to average 0.25 hours per response including the time for reviewing the instructions, searching existing data sources, gathering and maintaining the data as needed, and completing and reviewing the collection of information. Response to the information collection is mandatory. This agency may not collect this information, and you are not required to complete this form, unless the form displays a currently valid OMB control number.

Retailer Name & Address
Name	Street Address		City	State	Zip
Retailer/Distributor Representative (signature)		Date (mm/dd/yyyy)	Check box if report is for correcting previously reported information

Reporting Period: (mm/dd/yyyy) __________________ through (mm/dd/yyyy) ___________________ Page _____ of _____

Certification Label Number (include all zeros and agency prefix)	Manufacturer’s Serial Number (Including all letters and numbers)	Name of Home Manufacturer	Date of purchase or lease agreement (mm/dd/yyyy)	Name of Purchaser or Lessee	Home Installation Site Information
					Street Address	City	State	Zip	Local Authority Having Jurisdiction

Distribution: HUD
Retailer/Distributor

Form HUD-305