Form Bls 3020 - Multiple Worksite Report - New Jersey Dept Of Labor & Workforce Development
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Multiple Worksite Report - BLS 3020
New Jersey Dept of Labor & Workforce Development
Form Approved, O.M.B. No. 1220-0134
Div of Economic & Demographic Research, CET
Expiration Date: 05/31/2016
P.O. Box 934
In Cooperation w ith the U.S. Department of Labor
Trenton NJ 08625-0934
Phone: (609) 292-2633
New Jersey
This report is mandatory under New Jersey Unemployment Compensation Law, Section 43:21-11, 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 NJ-927).
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 NJ-927.
CONTACT PERSON (for questions regarding this report)
NAME: ________________________________________ PHONE: _____________________________________________
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