Form Bls 3020 - Multiple Worksite Report - Virginia Employment Commission
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Multiple Worksite Report - BLS 3020
Virginia Employment Commission
Form Approved, O.M.B. No. 1220-0134
Economic Information Services
Expiration Date: 08/31/2019
P.O. Box 1358
In Cooperation w ith the U.S. Department of Labor
Richmond VA 23218-0141
Phone: (804) 786-5807
Virginia
This report is mandatory under Virginia Unemployment Compensation Act, Section 60.2-114, 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 Virginia Employment Commission Employer's
Quarterly Tax Report (Form VEC-FC-20).
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 VEC-FC-20.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
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