Form HUD- 101 HUD- 101 Request for Labels

IPIA Request for Labels
(order control)

U.S. Department of Housing and Urban Development
Office of Regulatory Affairs and Manufactured Housing

OMB Approval No. 2502-0233
(expires 10/31/2006)

The Manufactured Housing Procedural and Enforcement Regulations 24 CFR Part 3282 Section 362 requires the Production Inspection Primary Inspection
Agency (IPIA) to obtain certificaiton labels from the Secretary or the Secretary's agent, and Section 501 authorizes the Secretary to take such actions to oversee the system as the Secretary deems appropriate. The information collected here will be used to request and confirm receipt of certified labels. Public
reporting burden for this collection is estimated to average 0.5 hours per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collected information. Response to this information
collection is mandatory 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 Address

Manufacturer’s Representative

Phone

Date (mm/dd/yyyy)

Request for Labels
(By IPIA Agency)

We hereby request _________________ certification labels for our on-hand inventory. Currently our inventory is
(Quantity)

________________ certification labels on hand. Based on our current rate of certification labels issued, the on-hand
(Quantity)

inventory will last for approximately________weeks.

Order Processing
(by HUD’s monitoring agent)

Date request received ______________ . The request for certification labels was placed with the label manufacturer
(mm/dd/yyyy)

by _______________________ on ____________________ in the quantity of _____________ certification labels.
(mm/dd/yyyy)

Note: If the quantity ordered is different than requested, it was authorized by ___________________________________.
(name)

This order should be received within the next three weeks.

Confirmation of Receipt
(to be completed by the IPIA)

We have received the quantity of certification labels authorized by HUD’s contracting agent.
If No, contact HUD’s monitoring agent immediately.

Yes _____ No _____.

This order was received on ____________________ and contained:
(mm/dd/yyyy)

Certification labels ______ - ______________ through & including ______ - ________________= ___________ (Quantity)
These labels were entered into this agency’s on-hand inventory on _____________________________________
(mm/dd/yyyy)

by IPIA authorized label administrator __________________________________________.
(signature)

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

Form HUD-101 (10/20/2006)