Information Collection

Multiple Worksite Report (Mandatory)

IC 178400 under ICR 201601-1220-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form BLS 3020 Multiple Worksite Report (Mandatory)	Form and Instruction
BLS 3020 Multiple Worksite Report 3020 - Mandatory MWR 3020_Mandatory.docx	Form and Instruction
MWRWeb MWRWeb - Mandatory MWRWeb Screenshots_Mandatory_Voluntary.pdf	Form and Instruction
Cover Letter_Mandatory.docx MWR Cover Letter - Mandatory	IC Document
Cover Letter_Mandatory (Web Only).docx MWR Cover Letter - Mandatory (Web Reporting)	IC Document
T1_Sample_Email.docx MWR Initial Email Notification	IC Document
T2_Sample_Email.docx MWR Email Reminder - Second Notification	IC Document
T3_Sample_Email.docx MWR Email Reminder - Third Notification	IC Document

IC Title:

Multiple Worksite Report (Mandatory)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	BLS 3020	Multiple Worksite Report 3020 - Mandatory	MWR 3020_Mandatory.docx		Yes	Yes	Fillable Printable
Form and Instruction	MWRWeb	MWRWeb - Mandatory	MWRWeb Screenshots_Mandatory_Voluntary.pdf		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 77,507

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 43 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	310,028	13,184	296,844
Annual IC Time Burden (Hours)	114,710	4,878	109,832
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MWR Cover Letter - Mandatory	Cover Letter_Mandatory.docx	03/02/2016
MWR Cover Letter - Mandatory (Web Reporting)	Cover Letter_Mandatory (Web Only).docx	03/02/2016
MWR Initial Email Notification	T1_Sample_Email.docx	03/02/2016
MWR Email Reminder - Second Notification	T2_Sample_Email.docx	03/02/2016
MWR Email Reminder - Third Notification	T3_Sample_Email.docx	03/02/2016

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