The Bureau of Labor Statistics of the U.S. Department of Labor is the principal Federal agency responsible for measuring labor market activity, working conditions, and price changes in the economy.
We appreciate your response within 14 days. Thank you.
Industry Verification Form, BLS 3023-NVS
Form Approved, O.M.B. No. 1220-0032
Expiration Date: 01/31/2021
In cooperation with the U.S. Department of Labor
Illinois Department of Employment Security
Economic Information and Analysis – QCEW
33 South State Street, 10th Floor
C hicago, IL 60603-2802
P hone: (312) 793-5843
F AX: (312) 793-3609
This report is authorized by law, 29 U.S.C. 2. Your cooperation is needed to make the results of this survey
complete, accurate, and timely. Purpose, use and help information are located on the back of this form.
BUSINESS MAILING ADDRESS Please print.
Business Name: __________________________________________
Street Address: ___________________________________________
City: ___________________________ ST: ______ ZIP: __________
Unemployment Insurance Account Number: ________________________________________ in Illinois.
Please list the
PHYSICAL LOCATION ADDRESS of your business location in Illinois. Please print.
Street Address: _____________________________________________ ___________________________
City: __________________________________________________ ST: Illinois ZIP: ________________
More than one physical location. Please attach a sheet listing each site and include: (1) business name (2) physical location address (3)
number of employees (4) county & (5) main business activity. Please don't count client sites or off -site projects lasting less than a year.
Business has employees w orking in Illinois but no physical location in Illinois. If so, please continue to Item 4.
Please provide the County where your business is physically located in Illinois.
MAIN BUSINESS ACTIVITY
We need detailed information to assign the correct North American Industry Classification System (NAICS) code
to this business. In the space provided below, describe your b