Form BLS 3020 MWR - Man BLS 3020 MWR - Man BLS 3020 Multiple Worksite Report - Mandatory

Utana Department of Labor
Labor Market Information
123 Main St.
Anytown, UT 12345-6789

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Multiple Worksite Report - BLS 3020
Form Approved, O.M.B. No. 1220-0134
Expiration Date 08/31/2019
In Cooperation with the U.S. Department of Labor

Utana Department of Labor

Please fill out this form with blue or black ink.

This report is mandatory under Utana Law 123, and is authorized by law, 29 U.S.C. 2. Your cooperation is needed to make the results
of this survey complete, accurate, and timely. The totals on this form must match the corresponding totals on your Employer's
Contribution Report (Form UT-111).

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WORKSITES

OFFICE
USE

***********************
* MWR WEB INFORMATION *
* ID: 106001234456
*
* Password: Ab123445 *
***********************
QUARTERLY WAGES
OF WORKSITES

GO PAPERLESS! REPORT YOUR DATA ON THE WEB.

BUSINESS NAME (division, subsidiary, etc.)
STREET ADDRESS (physical location)
CITY, STATE, AND ZIP CODE
WORKSITE DESCRIPTION (plant name, store number, etc.)
WORKSITE TRADE NAME
STREET ADDRESS
CITY, ST ZIP-ZIP+4
RUD

0100301518280000120191
00003
000001
721110
073

U.I. NUMBER
: 0012345678
QUARTER ENDING : MARCH 31, 2019
DUE DATE
: APRIL 30, 2019

Use your ID and Password to log into the secure website: https://idcf.bls.gov/

Please update address and contact information below

00001
000028
721110
073

QUARTERLY REPORT INFORMATION

JOHN SMITH
ABC CORP
123 LLC
PO BOX 123
SOMECITY, UT 12345-6789

WORKSITE TRADE NAME
STREET ADDRESS
CITY, ST ZIP-ZIP+4
RUD

0100301518280000320191

NUMBER OF
EMPLOYEES
(subject to UI Laws)
During the Pay Period Which
Includes the 12th of the Month
Place one (1) digit per box

(subject to UI laws)
Round to the nearest dollar
Do not use commas or decimal points
Place one (1) digit per box

JAN
FEB

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

MAR
JAN
FEB
MAR

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Note: The totals MUST agree (except for rounding) with
your Form UT-111.
CONTACT PERSON (for questions regarding this report).
NAME:
PHONE:

T
JAN
O
T
FEB
A
L MAR
S

$

.00

0000933

U.I. NUMBER: 0012345678 in Utana

INSTRUCTIONS
DUE DATE: Please return this form or a computer-generated facsimile by APRIL 30, 2019
Please follow these steps to prepare your Multiple Worksite Report. Contact the Agency listed in Step 6 if you have any questions or
if you need additional information, or see http://www.bls.gov/cew/cewmwr00.htm
1. Review the business name, contact name, and mailing address and make any necessary corrections (Section 2).
2. The Worksites list (Section 3), shows the individual worksites (business locations) that appear in our files for the U.I. Number.
Please read across the row for each worksite and do the following:
• NAME/ADDRESS/DESCRIPTION: Review the name and physical location address for each worksite and make any necessary
corrections. Review the description below the physical location to be sure it uniquely identifies each worksite (plant name, store
number, etc.). If there is no printed description, please enter a unique identifier for the site.
• EMPLOYMENT: Enter employment for each month of the quarter. Employment is the total number of full- and part-time
employees who worked during or received pay for the pay period which includes the 12th of the month. Include all
employees who were subject to Unemployment Insurance laws.
• WAGES: Enter wages paid during the quarter that are subject to State Unemployment Insurance laws, including the portion that
exceeds the State’s taxable wage base. Round wages to the nearest dollar.
• LARGE CHANGES: Use the space beside the worksite to explain any large changes in employment and/or wages.
Changes might result from store closings, strikes, layoffs, bonuses, seasonal increases or decreases, or similar events.
• CLOSED OR SOLD: If a worksite has been sold, closed, or is otherwise inactive, use the space beside the worksite to show:
(a) the date closed or sold; (b) if sold, the name of the company that bought the business at that worksite; and (c) the purchaser’s
U.I. Number, if you know it.
3. Is the list in Section 3 complete? That is, does the business operate any worksites using this U.I. Number that do not appear on
the form, such as newly-opened worksites or newly-acquired worksites?
MISSING WORKSITES: Provide the following information for each additional worksite. You may use available blank lines or
attach a separate page. If you are not sure how to report a worksite or employee, please call the office listed in Step 6 of these
instructions.
a. The business name, street or physical location address (NO POST OFFICE BOXES), city, state, and zip code
b. A unique description or identifier for each worksite (e.g., plant name, store number, or similar description)
c. The number of employees for each month of the quarter, and quarterly wages
d. The county, township, city, independent city, or similar geographic area in which the worksite is located
e. The main business activity at the worksite
In addition, if you purchased any of these worksites from another company, please provide:
f. The name of the company that sold the worksite
g. The effective date of the sale, and
h. The seller’s U.I. Number, if you know it.
4. Complete the Totals section at the end of the list. For each month, sum the number of employees at all worksites. Then sum the
wages for the quarter at all worksites. Except for rounding, these figures MUST agree with the totals on your Quarterly
Contributions Report.
5. Using the enclosed envelope, return your completed form to the central processing facility.
6. If you have questions, please contact your State Agency listed below:
Utana Department of Labor
Labor Market Information
123 Main St.
Anytown, UT 12345-6789
Phone: (123) 456-7899 Fax: (111) 222-3333

GENERAL INFORMATION
PURPOSE OF THIS REPORT
This Multiple Worksite Report (MWR) collects employment and wages by individual work location in this State. If you operate businesses from more than one location under
the Unemployment Insurance Account Number (U.I. Number) shown above, the MWR supplements your Quarterly Contributions Report. Data from the MWR enable our
agency to monitor and analyze conditions of business activities by geographic area and industry in this State. The information collected on this form by the Bureau of Labor
Statistics and the State agencies cooperating in its statistical programs will be used for statistical and Unemployment Insurance program purposes, and other purposes in
accordance with law.

PAPERWORK REDUCTION ACT STATEMENT

We estimate that this form will take from 10 minutes to 60 minutes to complete per response, with an average of 22 minutes. This includes time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this information. If you have any comments
regarding these estimates or any aspect of this form, send them to the Bureau of Labor Statistics, Division of Administrative Statistics and Labor Turnover, Room
4860, 2 Massachusetts Avenue N.E., Washington, D.C. 20212. The OMB control number for this survey is 1220-0134 and it expires on 08/31/2019. Without a
currently valid OMB number, BLS would not be able to conduct this survey.

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