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

All 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.

Click on the links in the table below to download a blank Industry Verification Form for your state.

State

Single Worksite BLS-3023 NVS Form

Multiple Worksite BLS-3023 NVM Form

Alabama

AL-3023-NVS

AL-3023-NVM

Alaska

AK-3023-NVS

AK-3023-NVM

Arizona

AZ-3023-NVS

AZ-3023-NVM

Arkansas

AR-3023-NVS

AR-3023-NVM

California

CA-3023-NVS

CA-3023-NVM

Colorado

CO-3023-NVS

CO-3023-NVM

Connecticut

CT-3023-NVS

CT-3023-NVM

Delaware

DE-3023-NVS

DE-3023-NVM

District of Columbia

DC-3023-NVS

DC-3023-NVM

Florida

FL-3023-NVS

FL-3023-NVM

Georgia

GA-3023-NVS

GA-3023-NVM

Hawaii

HI-3023-NVS

HI-3023-NVM

Idaho

ID-3023-NVS

ID-3023-NVM

Illinois

IL-3023-NVS

IL-3023-NVM

Indiana

IN-3023-NVS

IN-3023-NVM

Iowa

IA-3023-NVS

IA-3023-NVM

Kansas

KS-3023-NVS

KS-3023-NVM

Kentucky

KY-3023-NVS

KY-3023-NVM

Louisiana

LA-3023-NVS

LA-3023-NVM

Maine

ME-3023-NVS

ME-3023-NVM

Maryland

MD-3023-NVS

MD-3023-NVM

Massachusetts

MA-3023-NVS

MA-3023-NVM

Michigan

MI-3023-NVS

MI-3023-NVM

Minnesota

MN-3023-NVS

MN-3023-NVM

Mississippi

MS-3023-NVS

MS-3023-NVM

Missouri

MO-3023-NVS

MO-3023-NVM

Montana

MT-3023-NVS

MT-3023-NVM

Nebraska

NE-3023-NVS

NE-3023-NVM

Nevada

NV-3023-NVS

NV-3023-NVM

New Hampshire

NH-3023-NVS

NH-3023-NVM

New Jersey

NJ-3023-NVS

NJ-3023-NVM

New Mexico

NM-3023-NVS

NM-3023-NVM

New York

NY-3023-NVS

NY-3023-NVM

North Carolina

NC-3023-NVS

NC-3023-NVM

North Dakota

ND-3023-NVS

ND-3023-NVM

Ohio

OH-3023-NVS

OH-3023-NVM

Oklahoma

OK-3023-NVS

OK-3023-NVM

Oregon

OR-3023-NVS

OR-3023-NVM

Pennsylvania

PA-3023-NVS

PA-3023-NVM

Puerto Rico

PR-3023-NVS

PR-3023-NVM

Rhode Island

RI-3023-NVS

RI-3023-NVM

South Carolina

SC-3023-NVS

SC-3023-NVM

South Dakota

SD-3023-NVS

SD-3023-NVM

Tennessee

TN-3023-NVS

TN-3023-NVM

Texas

TX-3023-NVS

TX-3023-NVM

Utah

UT-3023-NVS

UT-3023-NVM

Vermont

VT-3023-NVS

VT-3023-NVM

Virgin Islands

VI-3023-NVS

VI-3023-NVM

Virginia

VA-3023-NVS

VA-3023-NVM

Washington

WA-3023-NVS

WA-3023-NVM

West Virginia

WV-3023-NVS

WV-3023-NVM

Wisconsin

WI-3023-NVS

WI-3023-NVM

Wyoming

WY-3023-NVS

WY-3023-NVM

 

Last Modified Date: July 31, 2017