Form C-MH-9A (5_20_22)

U.S. DEPARTMENT OF COMMERCE
U.S. CENSUS BUREAU

MANUFACTURED HOUSING SURVEY

FORM

C-MH-9A

(04-06-2021)

OMB No. 2528-0029: Approval Expires 6/30/2022

DUE DATE

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Section I - IDENTIFICATION OF MANUFACTURED HOME
Line 1 - Name of manufacturer
Line 2 - Manufacturer's serial number
Line 3 - HUD label number
Line 4 - Number of sections

55050017

Line 5 - Additional placement
information (if applicable)

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

Intended for Sale or Lease for RESIDENTIAL USE

b.

Sold or Leased for RESIDENTIAL USE

c.

Sold or Intended for Sale for NON-RESIDENTIAL USE (Do not complete section III and section IV.)

d.

Other - Explain below (Do not complete section III and section IV.)

CONTINUE ON PAGE 2

Form C-MH-9A

Page 2

(04-06-2021)

Section III - PRICE AND CHARACTERISTICS OF MANUFACTURED HOME
1. What is the WIDTH of this home, including all sections?

Feet

2. What is the LENGTH of this home?

Feet
Number

3. How many bedrooms are in this home?
4. Is this home leased or for lease ONLY?
Yes - continue to section IV
No
5. What is the sale price of this home, or if not sold, what is the list price?
(Include dealer setup costs. Exclude all taxes, land costs
and on-site improvements.)

$

.00

Section IV - PLACEMENT INFORMATION ON MANUFACTURED HOME
1. Has this home been placed at its final destination?
Yes - continue to question 2
No - end survey
2. How is this home titled?
a.

As real estate (property)

b.

As personal property

c.

Home is registered (licensed) and NOT titled

3. At what location was this home placed?

City

State

ZIP Code

4. Is this location...
a.

In a land-lease community / manufactured home community?

b.

On private property in a subdivision or planned unit
development?

c.

On other private property?

d.

Somewhere else? Please explain.

5. What type of footings is this home placed on? - if a or b, skip questions 6 and 7
a.

Monolithic slab foundation

b.

Basement / crawl space foundation

c.

Concrete footings

d.

Pressure-treated wood or ABS footings

e.

Some other type. Please explain.

d.

Some other type. Please explain.

c.

Some other means. Please explain.

55050025

6. What type of piers is this home placed on?
a.

Concrete blocks

b.

Pressure-treated wood blocks

c.

Manufactured steel or concrete stands

7. How is this home secured?
a.

Anchors and tie-down straps

b.

Anchors and an alternative foundation system

Thank you for completing your Manufactured Housing Survey.

Please retain a copy of your responses for your records.