U.S. flag

An official website of the United States government

Department of Labor Logo United States Department of Labor
Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Annual Refiling Survey (ARS) Respondents
PRINT:Print
CEW CEW Program Links

Annual Refiling Survey (ARS) Forms

The forms below are presented in PDF format. You will need Adobe Acrobat Reader to view the forms. For more information, see how to view a PDF File.

The Annual Refiling Survey is mandatory in the following states and territories:  CA, CT, CO, FL, GA, HI, IA, KS, LA, ME, MD, MT, NE, NM, NV, NH, NJ, NC, ND, OH, OK, OR, RI, SC (for employers with more than 20 employees), VT, VA, WV, PR, UT, and USVI.

Click on the links below to download a blank Industry Verification Form. Please complete the form and mail or fax it to the state that corresponds to the state in which the business is located.

  • Single Worksite BLS 3023-NVS Form (PDF)
  • Multiple Worksite BLS 3023-NVM Form (PDF)

Last Modified Date: September 18, 2024