Form HUD-304 Adjustment Report

Adjustment Report
Monthly Production Report

U.S. Department of Housing and Urban Development
Office of Manufactured Housing Programs

OMB Approval No. 2502-0233
expires 08/31/2019

The Manufactured Housing Procedural and Enforcement Regulations 24 CFR Chapter XX Part 3282 Section 552 requires manufacturers to report certification label usage on a monthly basis. This from requires
the manufacturer to report any adjustments to previously submitted monthly production reports. Public reporting burden for this collection of information 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 collection of information. Response to this information
collection is mandatory. 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. There are no assurances of
confidentiality.
Manufacturer’s Name & Address

Factory Name & Address

Manufacturer’s Representative

Phone

Report for month of (mm/yyyy)

Page ______ of ______

Section I
Certification
Label Number
(with all zeros)

IPIA Name
________

(to add an unreported unit)

Complete
Manufacturer’s
First
Serial Number
Home
(with all letters and Type
Date of
numbers including of Manufacture Location
2
unit, AC, and SC Unit1 (mm/dd/yyyy) Type
designations, etc.)

xxxxxxxxxxx xxxxxxxxxxxxxxxxx

Section II

Section III

IPIA Name
________

x

xx/xx/xxxx

x

First Location of Home Shipment
(if not the retailer or distributor address)

Retailer or Distributor Information

Name

Street Address

City/Town

xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx

State
xx

Zip

Name

Street Address

City/Town

xxxxx xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx

State

Zip

xx

xxxxx

Site
Brief Description of
Completion
On-Site Work
Numeric ID
(as needed)
(as needed)
(xxx-SC-xx)
xxx-xx-xx

xxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxx

(to correct previously reported information)

Certification Label
Number (include all zeros
and agency prefix)

Certification
Label Number
(with all zeros)

Date (mm/dd/yyyy)

Complete
Manufacturer’s M/H ID
or Serial Numbers

Date of Manufacture
(mm/dd/yyyy)

Correction
(for retailer change, include Name, City, and State)

Previous information

Type of
Unit1

(to be completed for open destinations)

Complete
Manufacturer’s
First
Serial Number
Home
(with all letters and Type
Date of
numbers including of Manufacture Location
2
unit, AC, and SC Unit1 (mm/dd/yyyy) Type
designations, etc.)

xxxxxxxxxxx xxxxxxxxxxxxxxxxx

Previous editions obsolete

x

xx/xx/xxxx

1Type

x

First Location of Home Shipment
(if not the retailer or distributor address)

Retailer or Distributor Information

Name

Street Address

City/Town

xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx

of Unit:
Single-wide Unit (S)
Multi-wide Unit 1st Section (1)
Multi-wide Unit 2nd Section (2)
Multi-wide Unit 3rd Section (3)

2Type

of Location:
(Specific purchaser, if known)
H - Homeowner
F – FEMA
R – Retailer
O - Other

State
xx

Zip

Name

Street Address

City/Town

xxxxx xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx

State

Zip

xx

xxxxx

Site
Brief Description of
Completion
On-Site Work
Numeric ID
(as needed)
(as needed)
(xxx-SC-xx)
xxx-xx-xx

xxxxxxxxxxxxxxxxxx
xxxxxxxxxxxxxxxxxx

Form HUD-304 (09/16)