Form Bls 3020 - Multiple Worksite Report - South Carolina Dept Of Employment And Workforce
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Multiple Worksite Report - BLS 3020
South Carolina Dept of Employment and Workforce
Form Approved, O.M.B. No. 1220-0134
Business Intelligence Department
Expiration Date: 05/31/2016
P.O. Box 995
In Cooperation w ith the U.S. Department of Labor
Columbia SC 29202
Phone: (803) 737-2660
South Carolina
This report is mandatory under Section 41-29-120 (except for employers with less than twenty-one employees), 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 Quarterly Contribution
and Wage Report (Form UCE-101/120).
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)
Total:
______
______
______ $ ___________.00
with your Form UCE-101/120.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
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