Form Bls 3020 - Multiple Worksite Report - Kansas Department Of Labor
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Multiple Worksite Report - BLS 3020
Kansas Department of Labor
Form Approved, O.M.B. No. 1220-0134
Labor Market Information/QCEW
Expiration Date: 08/31/2019
401 SW Topeka Boulevard
In Cooperation w ith the U.S. Department of Labor
Topeka KS 66603-3182
Phone: (785) 296-5000 extension 2579
Kansas
This report is mandatory under K.S.A. 44-714(e) Kansas Employment Security Law, 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 Quarterly Wage Report and Unemployment Tax Return
(Form K-CNS 100).
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 K-CNS 100.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
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