Form C-MH-9A Manufactured Housing Survey

Attachment 2a
FORM

C-MH-9A

OMB No. 2528-0029: Approval Expires 04/30/2016

(7-21-2014)

NOTICE — Your report to the Census Bureau is confidential by law (Title 13, U.S. Code).
It may be seen only by persons sworn to uphold the confidentiality of Census Bureau
information and may be used only for statistical purposes. The law also provides that copies
retained in your files are immune from legal process.

U.S. DEPARTMENT OF COMMERCE
Economic and Statistics Administration

U.S. CENSUS BUREAU
ACTING AS COLLECTION AGENT FOR

U.S. DEPARTMENT OF HOUSING
AND URBAN DEVELOPMENT

MANUFACTURED
HOUSING
SURVEY
RETAIN THIS FORM FOR YOUR FILES
(Please correct any error in name, address, and ZIP Code)

NOTE

At the request of the U.S. Department of Housing and Urban Development, the U.S. Census
Bureau is conducting this survey. The Census Bureau will release and publish only statistical
aggregates, which do not reveal the operations of individual dealers. Copies of the published
results will be available on request.

FROM THE DIRECTOR
U.S. CENSUS BUREAU
The Census Bureau requests your participation in the survey of new manufactured homes,
conducted for the Department of Housing and Urban Development. The Office of
Management and Budget has approved this survey and given it an 8-digit control number,
which is shown in the upper right-hand corner of this form. If this number was not displayed
we could not request your participation.
For the manufactured home identified in Section I on the back of this form, please complete
Sections II through IV, as needed. Manufacturers, suppliers, developers, and lenders use the
results of this voluntary survey to make more informed decisions concerning industry
production, investment, and financing.
We will contact you to obtain your information within a few days. If you
prefer, you may fax the form to us toll-free at 1–800–274–0761 or mail the
form to us in the enclosed postage-paid return envelope. If you choose to
mail or fax the form, please remember to retain a copy of this form for your
records.
We recognize that providing this information is a burden. To help minimize the burden, we
request information for only a sample of homes shipped by manufacturers and provide the
option of a toll-free response. The law that authorizes this survey (Title 13, United States
Code) requires that we keep your report strictly confidential. We will release and publish only
statistical aggregates, which do not reveal the operations of individual dealers.
If you have any questions, please contact the Census Bureau staff on 1–800–845–8249.
Thank you in advance for your cooperation.

We estimate that it will take from 15 to 25 minutes to complete this questionnaire and provide
answers to our representative when called, with 20 minutes being the average time. If you have
any comments regarding these estimates or any other aspect of this survey, including
suggestions for reducing the burden, send them to: Paperwork Project 2528-0029, U.S. Census
Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233-1500. You may e-mail
comments to [email protected]; use "Paperwork Project 2528-0029" as the subject. This
agency may not collect this information, and you are not required to complete this form, unless it
displays a current valid Office of Management and Budget control number.

AFTER COMPLETING THE REVERSE SIDE, PLEASE FAX,
MAIL OR RETAIN THIS FORM FOR A TELEPHONE INTERVIEW.

Attachment 2b

Section I – IDENTIFICATION OF MANUFACTURED HOME
Label identification information
Line 1 – Name of manufacturer
Line 2 – Manufacturer’s serial number
(first section only)
Line 3 – HUD label number
(first section only)
Line 4 – Type of home

Section II – CURRENT STATUS OF MANUFACTURED HOME
What is the current status of the home?
1

Intended for Sale for RESIDENTIAL USE – Please complete section III

2

Sold and Placed (or will be placed) for RESIDENTIAL USE – Please complete sections III and IV

3

Sold and Placed (or will be placed) for NON-RESIDENTIAL USE – Do not complete sections III and IV.

4

Other – Explain in the "Remarks" section. Do not complete sections III and IV.

Section III – PRICE AND CHARACTERISTICS OF MANUFACTURED HOME
1. What is the sales price of this home?
(Include options and dealer setup costs.
Exclude all taxes and land costs)

$

.00
Feet

2. What is the length of this home?
Feet

3. What is the width, including all sections?
Number

4. How many bedrooms are in this home?

Section IV – PLACEMENT INFORMATION ON MANUFACTURED HOME
1. How is this
home titled?

1
2

As real estate (property)
As personal property

2. At what location was this home placed?

ZIP Code

3

Home is registered (licensed)
and NOT titled
County

State

(Provide intended location, if not yet placed)
3. Is this location
1
2
3

4. Was this home
placed on

1

2

5. How is this home
secured?

1
2
3

In a park, court, or community?
In a subdivision or planned unit development?
NOT in any of the above?
A permanent masonry or concrete
foundation? – Skip question 5
Steel stands?

3
4

Blocks?
Some other way?

Secured by tie-down straps and anchors
Secured by some other means
NOT secured

Remarks

YOU MAY FAX THE FORM TO US TOLL-FREE AT 1–800–274–0761.
PLEASE RETAIN A COPY OF THIS FORM IF YOU CHOOSE TO MAIL OR FAX
FORM C-MH-9A (7-21-2014)