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 11/30/2022)

The Manufactured Housing Procedural and Enforcement Regulations 24 C.F.R. 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 under 42 U. S.C. 5413(c)(3) and (f). 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.

Privacy Notice:
HUD collects information in accordance with 42 U.S.C. 5413(c)(3) of the National Manufactured Housing Construction and Safety Standards Act of 1974 which requires manufacturers, under 42 U.S.C. 5413(f), to
maintain records, make reports and provide such information as HUD requires to determine whether the manufacturer is in compliance with the standards established under 42 U.S.C. 5403.
Purpose of this collection is necessary for accurate dispensation of program benefits and credits. Failure to comply with these regulations may subject the party in question to the civil and criminal penalties provided
for in section 611 of the Act, 42 U.S.C. 5410. While HUD generally only discloses this data in response to a Freedom of Information or audit request, any information collected pursuant to 42 U.S.C. 5413(b), (c), (f),
or (g) which contains or relates to a trade secret that would result in a substantial competitive disadvantage if disclosed shall be considered confidential and shall not be further disclosed except as required or
permitted under 42 U.S.C. 5413(h).

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

Date (mm/dd/yyyy)

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)

Previous editions obsolete

Complete
Manufacturer’s M/H ID
or Serial Numbers

1Type

Date of Manufacture
(mm/dd/yyyy)

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

Previous information

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

Type of
Unit1

Form HUD-304 (09/16)

Section III
Certification
Label Number
(with all zeros)

IPIA Name
________

(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

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