Modular Home Complaint Form

If you would like to submit the information below by mail, you can print a pdf version of the form here. Once you fill out the form, please mail it to the address below.

Nebraska Public Service Commission

Housing Department

PO Box 94927

Lincoln, NE 68509

Homeowner's Identification

Today's Date: Required

First Name: Required

Last Name: Required

Address: Required

Address:

City/Town/Village: Required

State: Required

Zip: Required

Daytime Phone: Required

Home Phone:

Mobile Phone:

Email Address: Required

Preferred Method of Correspondance: Required

Have you contacted the manufacturer about your complaint? Required

Have you contacted the retailer about your complaint? Required

Have you contacted an Attorney about your complaint? Required

Home Identification

Manufacturer Name: Required

State:

Serial Number:

Nebraska Modular Home Label Number:

Retailer's Name:

Retailer's City:

Retailer's State:

Purchase Date:

Move-in Date:

Nature of Complaint Required

Homeowner's Identification

Home Identification

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