Form Bls 3020 - Multiple Worksite Report - Virgin Islands Dept Of Labor
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Multiple Worksite Report - BLS 3020
Virgin Islands Dept of Labor
Form Approved, O.M.B. No. 1220-0134
Bureau of Labor Statistics
Expiration Date: 05/31/2016
P.O. Box 303359
In Cooperation w ith the U.S. Department of Labor
St. Thomas VI 00803-3359
Phone: (340)776-3700 ext 2034
Virgin Islands
This report is mandatory under Sections 309, 313, Chapter 12, Title 24 of the Virgin Islands Code, 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's Quarterly Wage and Contribution
Report (Form VIUIS-2).
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 VIUIS-2.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
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