Form BLS3020 "Multiple Worksite Report" - Arkansas

What Is Form BLS3020?

This is a legal form that was released by the Arkansas Department of Workforce Services - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the Arkansas Department of Workforce Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form BLS3020 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Workforce Services.

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Download Form BLS3020 "Multiple Worksite Report" - Arkansas

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__________________________________________________
Multiple Worksite Report - BLS 3020
Arkansas Dept of Workforce Services
Form Approved, O.M.B. No. 1220-0134
BLS Programs
Expiration Date: 08/31/2019
P.O. Box 2981
In Cooperation w ith the U.S. Department of Labor
Little Rock AR 72203-2981
Phone: (800) 682-5611
Arkansas
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 Employer's
Quarterly Contribution and Wage Report (Form DWS-ARK-209B).
BUSINESS MAILING ADDRESS
Please print.
QUARTERLY REPORT INFORMATION
Business Name: __________________________________________
U.I. NUMBER: ______________________
QUARTER ENDING: ___ / ___ / ___
Street Address: ___________________________________________
DUE DATE: ___ / ___ / ___
City: ___________________________ ST: ______ ZIP: __________
WORKSITES
BUSINESS NAME
(division, subsidiary, etc.)
NUMBER OF
QUARTERLY WAGES
OFFICE
STREET ADDRESS
(physical location)
EMPLOYEES
OF WORKSITES
USE
(subject to UI Law s) During the Pay Period
(subject to UI law s)
CITY, STATE, AND ZIP CODE
Which Includes the 12th of the Month
Round to the nearest dollar
WORKSITE DESCRIPTION
(plant name, store number, etc.)
Month 1
Month 2
Month 3
.00
.00
.00
.00
.00
.00
Note: The totals MUST agree (except for rounding)
0
0
0
$ 0
Total:
______
______
______ $ ___________.00
with your Form DWS-ARK-209B.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
__________________________________________________
Multiple Worksite Report - BLS 3020
Arkansas Dept of Workforce Services
Form Approved, O.M.B. No. 1220-0134
BLS Programs
Expiration Date: 08/31/2019
P.O. Box 2981
In Cooperation w ith the U.S. Department of Labor
Little Rock AR 72203-2981
Phone: (800) 682-5611
Arkansas
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 Employer's
Quarterly Contribution and Wage Report (Form DWS-ARK-209B).
BUSINESS MAILING ADDRESS
Please print.
QUARTERLY REPORT INFORMATION
Business Name: __________________________________________
U.I. NUMBER: ______________________
QUARTER ENDING: ___ / ___ / ___
Street Address: ___________________________________________
DUE DATE: ___ / ___ / ___
City: ___________________________ ST: ______ ZIP: __________
WORKSITES
BUSINESS NAME
(division, subsidiary, etc.)
NUMBER OF
QUARTERLY WAGES
OFFICE
STREET ADDRESS
(physical location)
EMPLOYEES
OF WORKSITES
USE
(subject to UI Law s) During the Pay Period
(subject to UI law s)
CITY, STATE, AND ZIP CODE
Which Includes the 12th of the Month
Round to the nearest dollar
WORKSITE DESCRIPTION
(plant name, store number, etc.)
Month 1
Month 2
Month 3
.00
.00
.00
.00
.00
.00
Note: The totals MUST agree (except for rounding)
0
0
0
$ 0
Total:
______
______
______ $ ___________.00
with your Form DWS-ARK-209B.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
INSTRUCTIONS
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. Num ber.
(a) Please read across the row for each worksite and do the following:
• NAME/ADDRESS/ DES CRIPTION: 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 i ncreases 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 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 o f
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
f. In addition, if you purchased any of these worksites from another company, please provide:
g. The name of the company that sold the worksite
h. The effective date of the sale, and
i. 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 th e
wages for the quarter at all worksites. Except for rounding, these figures MUST agree with the totals on your Employer's
Quarterly Contribution and Wage Report (Form DWS-ARK-209B).
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:
Arkansas Dept of Workforce Services
BLS Programs
P.O. Box 2981
Little Rock AR 72203-2981
Phone: (800) 682-5611
501-682-3190
Fax: (501)682-2942
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 y our 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 f or 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 f or reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this information. If you hav e 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 f or 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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