Form Bls 3020 - Multiple Worksite Report - Colorado Department Of Labor And Employment
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Multiple Worksite Report - BLS 3020
Colorado Dept of Labor and Employment
Form Approved, O.M.B. No. 1220-0134
La bor Market Information
Expiration Date: 08/31/2019
63 3 17th Street, Suite 600
In Cooperation w ith the U.S. Department of Labor
D enver CO 80202-2107
P hone: (303) 318-8867
Colorado
This report is mandatory under Colorado Law C.R.S. 8-72-107, 8-76-102.5, and 8-81-101, and is authorized by
law, 29 U.S.C. 2. Your cooperation is needed to make the results of this survey complete, acc urate, and timely.
The totals on this form must match the corresponding totals on your Unemployment Insurance Tax Report (Form
UITR1).
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 UITR1.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
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