An official website of the United States government
United States Department of Labor
United States Department of Labor
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.
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.
Multiple Worksite Report State FormsThe form below is 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 Multiple Worksite Report is mandatory in the following states and territories: AL, CA, CO, CT, FL (Mandatory for PEOs only), GA, HI, IA, KS, LA, ME, MD, MN, MS, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, RI, SC (for employers with more than 20 employees), TX (Mandatory for PEOs only), UT, VT, VA, WV, PR, and USVI. Click on the link below to download a blank Multiple Worksite Report form. Please complete the form and mail or fax it to the state that corresponds to the state in which your business is located.
Last Modified Date: April 24, 2026 |