BLS 3020 MWR - Vol BLS 3020 Multiple Worksite Report - Voluntary

Arizona Office of Economic Opportunity
P.O. Box 6029
Phoenix, AZ 85005-9860

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Multiple Worksite Report - BLS 3020
Form Approved, O.M.B. No. 1220-0134
Expiration Date 10/31/2022
In Cooperation with the U.S. Department of Labor

Please fill out this form with blue or black ink.

Arizona Office of Economic Opportunity

This report 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 Unemployment Tax and Wage Report (Form UC-018).

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MWR-A0024734 P-0004 T-0110
ABC COMPANY
123 FIRST ST
CITY, AZ 12345-6789

00024734

QUARTERLY REPORT INFORMATION

1 AB 0.428

U.I. NUMBER
: 1234567890
QUARTER ENDING : DECEMBER 31, 2021
DUE DATE
: JANUARY 31, 2022

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WORKSITES

OFFICE
USE

GO PAPERLESS! REPORT YOUR DATA ON THE WEB.
Use your ID and Password to log into the secure website: https://idcf.bls.gov/

BUSINESS NAME (division, subsidiary, etc.)
STREET ADDRESS (physical location)
CITY, STATE, AND ZIP CODE
WORKSITE DESCRIPTION (plant name, store number, etc.)
Please update address and contact information below

00001
000016
623220
021

ABC COMPANY DEPT
123 1ST ST
CITYVILLE, AZ 12345

0400012438900000120214
00002
000035
623220
013

ABC COMPANY
8 MAIN ST
TOWNVILLE, AZ 98765

0400012438900000220214
00003
000007
623220
019

***********************
* MWR WEB INFORMATION *
* ID: 106001234567
*
* Password: Aa123456 *
***********************

ABC COMPANY
444 PARK AVE
TOWNHALL, AZ 85706

0400012438900000320214

NUMBER OF
EMPLOYEES

QUARTERLY WAGES
OF WORKSITES

(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

OCT
NOV

$

.00

$

.00

$

.00

$

.00

$

.00

$

.00

DEC
OCT
NOV
DEC
OCT
NOV
DEC

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Note: The totals MUST agree (except for rounding) with
your Form UC-018.
CONTACT PERSON (for questions regarding this report).
NAME: SALLY BLS
PHONE: (222) 555-7890

T
OCT
O
T
NOV
A
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S

$

.00
1

1112223334
0010602

U.I. NUMBER: 1234567890 in Arizona

INSTRUCTIONS
DUE DATE: Please return this form or a computer-generated facsimile by JANUARY 31, 2022
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 https://www.bls.gov/respondents/mwr
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:
Arizona Office of Economic Opportunity
P.O. Box 6029
Phoenix, AZ 85005-9860
Phone: (602) 771-1110 Fax: (602) 771-1207
Phone: 1-800-321-0381 (IN STATE)

Email: MWR_AZ@bls.gov

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 10/31/2022. Without a
currently valid OMB number, BLS would not be able to conduct this survey.

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