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Dispute Resolution Certification |
U. S. Department of Housing and Urban Development Office of Housing Federal Housing Commissioner |
OMB Approval No. 2502-XXXX (exp. (xx/xx/xxxx) |
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Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Provision of this information is mandatory. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. |
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Pursuant to 42 U.S.C. § 5422(g) (section 623(g) of the National Manufactured Housing Construction and Safety Standards Act of 1974) HUD will implement a dispute resolution program in each State that does not have a program meeting the requirements of 42 U.S.C. § 5422(c)(12). This Dispute Resolution Certification Form will be used for states to self-certify the adequacy of the state’s dispute resolution program and for HUD to review that self-certification. Acceptance of your state’s program will be determined by reviewing whether the response to Part II of this form complies with the requirements of 24 C.F.R. 3288.205. Your answers to the following questions are requested for a proper review. |
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Submit completed form to: |
Office of Manufactured Housing Programs Department of Housing and Urban Development 451 7th Street, SW Room 9164 Washington, DC 20410 |
For Parts I, II, and III, please answer each question concisely and certify the responses as full and accurate at the end of the form. Use additional pages if necessary.
Part I |
Name, address, telephone number, and email address of the state agency responsible for administering the dispute resolution program: |
Name and title of the administrator or director in charge of the state agency: |
Name, title, address, telephone number, and email address of the person responsible for administering the dispute resolution program: |
Part II |
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Indicate whether the state dispute resolution program being administered meets the following minimum requirements: |
Yes |
No |
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Part III – Additional Information |
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Part III – Additional Information (continued) |
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Part IV |
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COMPLIANCE CERTIFICATION |
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I hereby certify to the best of my knowledge that the answers given are truthful, accurate, and complete. |
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Date: |
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(Signature) |
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Print or type name of signatory |
Print or type name of signatory’s title |
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(State) |
File Type | application/msword |
File Title | In accordance with 42 U |
Author | HUD |
Last Modified By | HUD |
File Modified | 2007-06-18 |
File Created | 2007-06-18 |