Form HUD 310-DRSC HUD 310-DRSC Dispute Resolution Certification

Federal Manufactured
Housing Dispute
Resolution Information
Form

U. S. Department of Housing and
Urban Development
Office of Housing
Federal Housing Commissioner

OMB Approval No. 2502-0562
(exp. 04/30/2015)

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. This information
is required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid
OMB control number.
42 U.S.C. § 5422(g) (section 623(g) of the National Manufactured Housing Construction and Safety Standards Act of 1974) authorizes HUD to implement
a dispute resolution program in each State that does not have a program meeting the requirements of42 U.S.C. § 5422(c)(12). Your answers to the
following questions are necessary for a proper evaluation of your dispute. The respondents are homeowners, installers, retailers, and manufacturers of
manufactured housing. HUD does not pledge assurance of confidentiality to respondents. HUD generally discloses this data only in response to a
Freedom of Information request.

Initial Information
Name of person requesting assistance in resolving dispute:
Homeowner
Role in the dispute: (check one)
___
Homeowner
Other parties involved in this dispute:
___

Manufacturer
___
Manufacturer
___

Retailer
___
Retailer
___

Installer
___
Installer
___

Information on the home
Street address of home:
City:

State:

Zip:

Daytime phone:
Evening or weekend phone:
E-mail address:
Name of manufactured home park, if applicable:
Single-wide:

Double-wide:

Multi-wide:

Serial number of home:
Model number of home:
HUD label number:
Date home was purchased:
Date home was delivered to the installation site:
Date home was installed:

Additional information on person requesting the dispute resolution
Name:
Street address:
City:

State:

Zip:

Daytime phone:
Evening or weekend phone:
E-mail address:
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form HUD-311-DR
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Manufacturer of Home
(Corporate name if known)
Company name of manufacturer:
Name of manufacturing plant in which home was built:
Name of contact person at plant if known:
Street address:
City:

State:

Zip:

Telephone:
E-mail address:

Retailer of Home
Name of Retailer:
Name of contact person or salesperson at retailer:
Street address:
City:

State:

Zip:

Telephone:
E-mail address:

Installer of Home
Name of company that installed the home:
Name of person that installed the home:
Name of contact person for the installation company:
Street address of installer’s company:
City:

State:

Zip:

Telephone:
E-mail address:

Description of Dispute (use additional sheets if necessary)

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form HUD-311-DR
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Description of the dispute:

Have you previously written to the federal Office of Manufactured Housing Programs regarding this or
other issues involving this home?
Have you contacted the [manufacturer, retailer or installer] regarding your complaint?
Retailer & Installer

If yes:
Person/firm contacted

Date(s)
Contacted

In writing or by phone?

Person/firm contacted

Date(s)
Contacted

In writing or by phone.

Person/firm contacted

Date(s)
Contacted

In writing or by phone.

Person/firm contacted

Date(s)
Contacted

In writing or by phone?

Attach copies of all written correspondence to or from the manufacturer, retailer, installer, or
homeowner. Also, attach copies of any other documentation to support your dispute. These
documents will not be returned.
Printed Name of person submitting complaint:
Signature:

Date:

Description of Dispute (continued)

Clear All

Print
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form HUD-311-DR
(8/2005)