Manufactured Housing Survey

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

MANUFACTURED HOUSING SURVEY

FORM

C-MH-9A

(05-19-2016)

OMB No. 2528-0029: Approval Expires 6/30/2019

DUE DATE

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Need help or have questions?
Call: 1-800-845-8249

Report online at:

https://econhelp.census.gov/mhs
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- OR -

Mail your completed form to:

U.S. CENSUS BUREAU
1201 East 10th Street

Jeffersonville, IN 47132-0001

- OR -

Fax your completed form to:
1-800-274-0761

NOTICE — Your report to the Census Bureau is confidential by law (Title 13, U.S. Code, Section 9). 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.

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)

55050017

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.

CONTINUE ON PAGE 2

Form C-MH-9A

Page 2

(05-19-2016)

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

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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

As real estate (property)

2

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

4. Was this home
placed on

5. How is this home
secured?

1

In a park, court, or community?

2

In a subdivision or planned unit development?

3

NOT in any of the above?

1

A permanent masonry or concrete
foundation? - Skip question 5

3

Blocks?

2

Steel stands?

4

Some other way?

1

Secured by tie-down straps and anchors

2

Secured by some other means

3

NOT secured

REMARKS (Please use this space for any explanations that may be essential in understanding your reported data.)

55050025

$$CENSUS_REMARKS$$

Thank you for completing your Manufactured Housing Survey.
Please retain a copy of your responses for your records.