IPIA Request for Labels (order control) U.S. Department of Housing and Urban Development Office of Manufactured Housing Programs OMB Approval No. 2502-0233 (expires 12/31/2009) 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. The information collected here will be used to report home distribution, collect fees, and reimburse parties as appropriate under these Regulations. 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. Manufacturer’s Name & Address Factory Address Manufacturer’s Representative Phone Date (mm/dd/yyyy) Request for Labels (By IPIA Agency) We hereby request _________________ certification labels for our on-hand inventory. Currently our inventory is (Quantity) ________________ certification labels on hand. Based on our current rate of certification labels issued, the on-hand (Quantity) inventory will last for approximately________weeks. Order Processing (by HUD’s monitoring agent) Date request received ______________ . The request for certification labels was placed with the label manufacturer (mm/dd/yyyy) by _______________________ on ____________________ in the quantity of _____________ certification labels. (mm/dd/yyyy) Note: If the quantity ordered is different than requested, it was authorized by ___________________________________. (name) This order should be received within the next three weeks. Confirmation of Receipt (to be completed by the IPIA) We have received the quantity of certification labels authorized by HUD’s contracting agent. If No, contact HUD’s monitoring agent immediately. Yes _____ No _____. This order was received on ____________________ and contained: (mm/dd/yyyy) Certification labels ______ - ______________ through & including ______ - ________________= ___________ (Quantity) These labels were entered into this agency’s on-hand inventory on _____________________________________ (mm/dd/yyyy) by IPIA authorized label administrator __________________________________________. (signature) Distribution Original - HUD’s Contracting Agent Copies to: IPIA Manufacturer Previous editions obsolete Form HUD-101 (1/00) American LegalNet, Inc. www.FormsWorkflow.com