Information Collection

Multiple Worksite Report

IC 169092 under ICR 199312-1220-004 · OMB 1220-0134.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0134 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

MULTIPLE WORKSITE REPORT

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	BLS 3020				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 104,849

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	456,296	20	456,276
Annual IC Time Burden (Hours)	168,883	60	168,823
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.