Form HUD-301 Request and Payment for Labels

Request and Payment
for Labels

U.S. Department of Housing and Urban Development
Office of Regulatory Affairs and Manufactured Housing

OMB Approval No. 2502-0233
expires 10/31/2006

The Manufactured Housing Procedural and Enforcement Regulations 24 CFR Part 3282 Section 362 requires manufacturers to request certification labels
from their Production Inspection Primary Inspection Agencies (IPIAs), and Section 501 authorizes the Secretary to take such actions to oversee the system as
the Secretary deems appropriate. The information collected here will be used by manufacturers to request certification labels from the IPIAs, and for the IPIAs
to assign the labels to the manufacturers. 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). 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.
Manufacturer’s Name & Address

Factory Address

Manufacturer’s Representative

Phone

Date (mm/dd/yyyy)

Manufacturer’s Request
(to be completed by manufacturer)

We hereby request that our IPIA, _____________________________________________________________________,
for the above manufacturing facility issue ________________(quantity) manufactured home certification labels.
Total number of labels requested ___________________________________ x $24.00 = $ ______________________
Credit adjustment (include Form 303 with credit)

– $ ______________________

Check amount

$ ______________________

Check number __________________________ dated ______________
(mm/dd/yyyy)

Checks must be made payable to Department of Housing and Urban Development.

IPIA Assignment of Label Numbers
(to be completed by IPIA)

The following unissued certification label numbers are assigned to the specific facility identified above.
Certification Labels _____ - _____________ through & including _____ - ______________ = ___________ (Quantity)
Certification Labels _____ - _____________ through & including _____ - ______________ = ___________ (Quantity)
Certification Labels _____ - _____________ through & including _____ - ______________ = ___________ (Quantity)
Total Number of Labels Issued ______________________________________ x $24.00 = $ ________________________
IPIA Authorized Label Administrator ______________________________________________ Date __________________
(signature)

(mm/dd/yyyy)

Mail one copy and label payment check to HUD lock box listed below:
Department of HUD
Manufactured Housing Inspection Fee
P.O. Box 198225
Atlanta, GA 30384
Distribution
Original - HUD’s Contracting Agent
Copies to: IPIA
Manufacturer
Previous editions obsolete

Form HUD-301 (10/20/2006)