Form OS-2001 Private Rental Survey, Trailer Spaces

PRIVATE RENTAL SURVEY
TRAILER SPACES

Office of the Secretary (OS)
Form 2001

Trailer Park Name:

Street Address of Trailer Pad:

Owner/Agent Name:

Pad City:

Owner/Agent Phone:

Survey Community and State:

Owner/Agent Address or Email:

Comp I.D. Number:

Owner/Agent City:
Owner:

State:
Agent:

Tenant:

Zip Code:

OMB Control Number 1084-0033
Expires xx-xx-xxxx

State:

Zip Code:

Community Code:
Contractor’s Representative:

Date Collected:

TRAILER PARK SITE DATA (FILL IN APPROPRIATE BLANKS AND CHECK BEST CHOICE)
1. Total Square Feet
(Single-wide sites only)
2. Monthly Contract Rent, single-wide
(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
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 4 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 4262, 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 4262, Washington, DC 20240.

OS-2001