Form Bls 3020 - Multiple Worksite Report - New York State Department Of Labor Page 2

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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

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 Quarterly

Combined Withholding, Wage Reporting and UI Return (Form NYS-45).

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:

New York State Department of Labor

Division of Research and Statistics

P.O. Box 15001

Albany NY 12240

Phone: (518) 485-8145

Fax: (518) 485-7810

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 .