Form Bls 3020 - Multiple Worksite Report - Florida Department Of Economic Opportunity
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Multiple Worksite Report - BLS 3020
Florida Department of Economic Opportunity
Form Approved, O.M.B. No. 1220-0134
Bureau of Labor Market Statistics
Expiration Date: 08/31/2019
107 East Madison St, MSC G-020
In Cooperation w ith the U.S. Department of Labor
Tallahassee FL 32399-4111
Phone: (800) 672-4664
Florida
This report is mandatory under Florida Statutes, Chapter 443, 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 Tax Report (Form RT-6).
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 RT-6.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
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