Multiple Worksite Report (Mandatory)

State Agency Name

State Department Name

State Address 1 and 2

City, ST ZIP

Phone: 123-456-7890

UNITED STATES DEPARTMENT OF LABOR

Bureau of Labor Statistics

Postal Square Building, Suite 4840

2 Massachusetts Ave., N.E.

Washington, DC 20212-0001

MANDATORY

Contact Name

Trade Name

Legal Name

Mailing 1

Mailing 2

City ST ZIP

September 2015

Dear Employer,

The U.S. Bureau of Labor Statistics (BLS) and your State agency request that you provide your company’s employment and wages each quarter using the BLS 3020 - Multiple Worksite Report (MWR).

To reduce costs and save tax dollars, this report has been moved online. Please use the Web ID and password below to log into our secure website: https://idcf.bls.gov/

WEB ID: 99123456789 PASSWORD: Ab123456

This report is mandatory in accordance with the UTANA LAW 123 and is authorized by 29 U.S. Code, Section 2 and is approved by O.M.B. No. 1220-0134.

Multiple Worksite Report data enable BLS to monitor and analyze conditions of business activities by geographic area and industry. Information collected in this report by BLS and State agencies cooperating in its statistical programs will be used for statistical and Unemployment Insurance program purposes, and other purposes in accordance with law. Additional information can be found online: http://www.bls.gov/cew/cewmwr00.htm.

The due date for your response is October 31, 2015. Thank you for your cooperation.

Sincerely,

Emily Thomas

U.S. Bureau of Labor Statistics