Form 939 2015 939 ACA AIR Readiness
E-Government Website Customer Satisfaction Surveys
2015 939 ACA AIR Readiness.xlsx
2015 939 ACA AIR Readiness - 2015 942 NIJ v3
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Model Qsts
Current CQs
Overview
Welcome and Thank You TextModel Qsts
Current CQs
Sheet 1: Welcome and Thank You Text
|
||||||
| Welcome and Thank You Text | ||||||
| Welcome Text | Thank You Text | |||||
| Thank you for your willingness to provide feedback on the Affordable Care Act Information Returns (AIR) Program on the IRS website. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. |
Thank you for taking our survey - and for helping us serve you better. We appreciate your input! |
|||||
| Welcome Text - Alternate | Thank You Text - Alternate | |||||
Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site. |
||||||
|
|
|||||
Sheet 2: Model Qsts
| Model Name IRS ACA AIR Survey | ||||||
| Model ID | ||||||
| Partitioned NO | ||||||
| Date (9/2/2015) | ||||||
| Label | Satisfaction Questions | |||||
| Satisfaction - Overall | What is your overall satisfaction with the Affordable Care Act Information Returns (AIR) Program as an information resource on IRS.gov? (1=Very Dissatisfied, 10=Very Satisfied) |
|||||
| Satisfaction - Expectations | How well does the Affordable Care Act Information Returns (AIR) Program as an information resource on IRS.gov meet your expectations? (1=Falls Short, 10=Exceeds) |
|||||
| Satisfaction - Ideal | How does the Affordable Care Act Information Returns (AIR) Program on IRS.gov compare to an ideal information resource? (1=Not Very Close, 10=Very Close) |
|||||
Sheet 3: Current CQs
| Model Name IRS ACA AIR Survey |
|
||||||||
| Model ID | Underlined & Italicized: Re-order | ||||||||
| Partitioned NO | Pink: Addition | ||||||||
| Date (9/11/2015) | Blue: Reword | ||||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label | |
| Which category best describes you? Are you …? | Applicable Large Employer “ALE” with 50 or more FTE employees (Non-Governmental) | C1-C11 | Y | Radio button, one-up vertical | Skip Logic Group* | Role | |||
| Applicable Large Employer "ALE" (Governmental-federal, state, local, Indian tribal) | C1-C11 | ||||||||
| Health Insurance Issuer (Non-Profit or For-Profit) | B1-B11 | ||||||||
| Government Sponsored Insurance (Medicaid/CHIP, Medicare, Tricare, Veterans' Health Coverage) | B1-B11 | ||||||||
| Software developer | A1-A14 | ||||||||
| Transmitter | A1-A14 | ||||||||
| Other | X,C1-C11 | ||||||||
| X | Please specify what best describes you. | N | Text field, <100 char | Skip Logic Group* | Other role | ||||
| A1 | Thinking about the planning and preparation needed for the Affordable Care Act (ACA) requirements, please rate how ready your organization is to fulfill the technical requirements for transmitting information returns (Forms 1094-B/C, 1095-B/C) to the IRS. | 1=Not at all ready | Y | Drop down, select one | Software Tech requirements |
||||
| 2= In process, partially ready | |||||||||
| 3=Completely ready | |||||||||
| Don't know | |||||||||
| N/A | |||||||||
| A2 | Which ACA Information Returns are you now (or will you be) transmitting? (Choose all that apply) | 1095-B | Y | Checkbox, one-up vertical | Software Info returns |
||||
| 1095-C | |||||||||
| Both | |||||||||
| Unsure | |||||||||
| A3-1 | Please rank how helpful you found the following Publications or Guides for the ACA Information Return System (AIR): Publication 5164 |
1=Not at all helpful | Y | Drop down, select one | Multiple Lists Group* | Software Pub 5164 |
|||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5=Very helpful | |||||||||
| N/A | |||||||||
| A3-2 | Publication 5165 | 1=Not at all helpful | Y | Drop down, select one | Multiple Lists Group* | Software Pub 5165 |
|||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5=Very helpful | |||||||||
| N/A | |||||||||
| A3-3 | Automated Enrollment for ACA Information Returns External User Guide | 1=Not at all helpful | Y | Drop down, select one | Multiple Lists Group* | Software Auto enrollment |
|||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5=Very helpful | |||||||||
| N/A | |||||||||
| A3-4 | AIR Submission Composition and Reference Guide | 1=Not at all helpful | Y | Drop down, select one | Multiple Lists Group* | Software AIR submission |
|||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5=Very helpful | |||||||||
| N/A | |||||||||
| A4 | What additional information should be included in IRS's Publications and Guides for AIR? | N | Text area, no char limit | Software Add info pubs |
|||||
| A5 | Is there technical guidance you need that you could not find on the AIR web pages? | Yes | A6 | Y | Radio button, one-up vertical | Skip Logic Group* | Software Tech guidance |
||
| No | |||||||||
| A6 | Please describe the technical guidance you were unable to find. | N | Text area, no char limit | Skip Logic Group* | Software Unable tech guidance |
||||
| A7 | Have you subscribed to the QuickAlerts Affordable Care Act Information Return (AIR) category? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | Software QuickAlerts |
|||
| No | |||||||||
| Unsure | |||||||||
| N/A | |||||||||
| A8 | Have you participated in the ACA Assurance Testing System (AATS) for the voluntary year (Tax Year 2014)? | Yes | Y | Drop down, select one | Software Participate AATS |
||||
| No | |||||||||
| N/A | |||||||||
| A9 | Will you be ready to complete the ACA Assurance Testing System (AATS) for the mandatory year (Tax Year 2015)? | Yes | A12 | Y | Radio button, one-up vertical | Skip Logic Group* | Software Ready to complete |
||
| No | A10 | ||||||||
| Testing already completed for mandatory year (Tax Year 2015) | A12 | ||||||||
| N/A | A12 | ||||||||
| A10 | What best describes the reason why you are not ready to complete ACA Assurance Testing System (AATS) ? (Select one answer from the list below) | Unable to complete the scenario(s) and associated forms required for the test | Y | Radio button, one-up vertical | Skip Logic Group* | Software Why not ready |
|||
| Unable to split submissions to meet 100MB form data file constraint | |||||||||
| Unable to complete the AIR TCC (Transmitter Control Code) application process | |||||||||
| Unable to obtain strong authentication certificate/credential to use A2A (Application to Application) | |||||||||
| Insufficient business rules to build programming | |||||||||
| Insufficient schemas to build programming | |||||||||
| Did not receive the WSDLs (Web Services Description Languages) in sufficient time to complete programming | |||||||||
| Other | A11 | ||||||||
| A11 | Please describe what is keeping you from being ready to complete AATS testing for the mandatory year (Tax Year 2015)? | N | Text area, no char limit | Skip Logic Group* | Software Other not ready |
||||
| A12 | What could we do to improve the AATS testing process? | N | Text area, no char limit | Software Improve AATS |
|||||
| A13 | Have you participated in the AIR Working Group Meetings (webinars)? | Yes | A14 | Y | Radio button, one-up vertical | Skip Logic Group* | Software Working group |
||
| No | |||||||||
| A14 | How helpful are the AIR Working Group Meetings (webinars)? | 1=Not at all helpful | Y | Radio button, one-up vertical | Skip Logic Group* | Software Helpful working group |
|||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5=Very helpful | |||||||||
| N/A | |||||||||
| B1 | How many individuals do you provide coverage for? | 0-49 | Y | Drop down, select one | Issuer # of individuals |
||||
| Between 50-499 | |||||||||
| Between 500-1999 | |||||||||
| Between 2,000-4,999 | |||||||||
| Between 5,000-9,999 | |||||||||
| 10,000 or more | |||||||||
| B2 | Please indicate how many states your business operates in? | One | Y | Drop down, select one | Issuer # of states |
||||
| Between 2-5 | |||||||||
| Between 6-10 | |||||||||
| Between 11-20 | |||||||||
| Over 20 states | |||||||||
| B3 | What best describes how you plan to handle your Affordable Care Act (ACA) reporting requirements? | Not yet decided | Y | Radio button, one-up vertical | Skip Logic Group* | Issuer Reporting requirements |
|||
| I will be outsourcing the reporting requirements | B4 | ||||||||
| I plan to handle the reporting requirements in-house | |||||||||
| I have already outsourced the reporting requirements | B4 | ||||||||
| I have already handled the reporting requirements in-house | |||||||||
| Other | |||||||||
| B4 | If you stated that you were planning on outsourcing or have already outsourced your reporting for ACA, which of the following types of vendors are you using? | Benefits administrator or Tax/accounting provider | Y | Checkbox, one-up vertical | Skip Logic Group* | Issuer Vendors | |||
| Tax information reporting firm | |||||||||
| Payroll vendor | |||||||||
| Human Resources provider | |||||||||
| Dedicated ACA compliance vendor | |||||||||
| Other | |||||||||
| Unknown/undecided | |||||||||
| B5-1 | Thinking about the planning and preparation needed for the ACA requirements, please rate how ready your organization is to fulfill the requirements for transmitting information returns (Form 1094-B and 1095-B) to the IRS. | 1=Not at all ready | Y | Drop down, select one | Multiple Lists Group* | Issuer Requirements |
|||
| 2= In process, partially ready | |||||||||
| 3=Completely ready | |||||||||
| Don't know | |||||||||
| N/A | |||||||||
| B5-2 | Collecting and updating insured individuals' monthly data for Form 1095-B reporting | 1=Not at all ready | Y | Drop down, select one | Multiple Lists Group* | Issuer Collecting updating |
|||
| 2= In process, partially ready | |||||||||
| 3=Completely ready | |||||||||
| Don't know | |||||||||
| N/A | |||||||||
| B6 | Have you participated in the AIR Working Group Meetings (webinars)? | Yes | B7 | Y | Radio button, one-up vertical | Skip Logic Group* | Issuer Working group |
||
| No | |||||||||
| B7 | How helpful are the AIR Working Group Meetings (webinars)? | 1=Not at all helpful | B8 | Y | Radio button, one-up vertical | Skip Logic Group* | Issuer Helpful working group |
||
| 2 | B8 | ||||||||
| 3 | B8 | ||||||||
| 4 | |||||||||
| 5=Very helpful | |||||||||
| N/A | |||||||||
| B8 | What suggestions do you have to improve AIR Working Group Meetings (webinars)? | N | Text area, no char limit | Skip Logic Group* | Issuer Improve working group |
||||
| B9 | Are you planning on filing an extension for the 2016 mandatory filing deadline? | Yes | Y | Drop down, select one | Issuer Filing extension |
||||
| No | |||||||||
| Unsure | |||||||||
| N/A | |||||||||
| B10 | How do you plan to deliver the information forms to covered individuals for their own ACA tax reporting/filing? | Electronically | Y | Drop down, select one | Issuer Deliver forms |
||||
| In paper format | |||||||||
| Both | |||||||||
| B11 | What could IRS do to help you satisfy the ACA information reporting requirements? | N | Text area, no char limit | Issuer Improve reporting |
|||||
| C1 | How many employees do you have? | 0-49 | Y | Drop down, select one | Employer # of individuals |
||||
| Between 50-499 | |||||||||
| Between 500-1,999 | |||||||||
| Between 2,000-4,999 | |||||||||
| Between 5,000-9,999 | |||||||||
| 10,000 or more | |||||||||
| C2 | What best describes how you plan to handle your company’s Affordable Care Act (ACA) reporting requirements? | Not yet decided | Y | Radio button, one-up vertical | Skip Logic Group* | Employer Reporting requirements |
|||
| I will be outsourcing the reporting requirements | C3 | ||||||||
| I plan to handle the reporting requirements in-house | |||||||||
| I have already outsourced the reporting requirements | C3 | ||||||||
| I have already handled the reporting requirements in-house | |||||||||
| Other | |||||||||
| C3 | If you stated that you were planning on outsourcing or have already outsourced your reporting for ACA, which of the following types of vendors are you using? | Benefits administrator or Tax/accounting provider | Y | Checkbox, one-up vertical | Skip Logic Group* | Employer Vendors | |||
| Tax information reporting firm | |||||||||
| Payroll vendor | |||||||||
| Human Resources provider | |||||||||
| Dedicated ACA compliance vendor | |||||||||
| Other | |||||||||
| Unknown/undecided | |||||||||
| C4 | How do you plan to deliver the information forms to your employees for their own ACA tax reporting/filing? | Electronically | Y | Drop down, select one | Employer Deliver forms |
||||
| In paper format | |||||||||
| Both | |||||||||
| C5 | Please select the option that best describes your preparations for ACA's information reporting requirements: | I have begun tracking employee hours for ACA | Y | Radio button, one-up vertical | Employer Preparation |
||||
| I have not yet begun tracking employee hours for ACA, but I am working on it | |||||||||
| I have not yet begun tracking employee hours for ACA, and I have not started working on it | |||||||||
| None of the above | |||||||||
| C6-1 | Thinking about the planning and preparation needed for the ACA requirements, please rate how ready your organization is to fulfill the requirements for transmitting information returns (Forms 1094-C, 1095-C) to the IRS. | 1=Not at all ready | Y | Drop down, select one | Multiple Lists Group* | Employer Requirements |
|||
| 2= In process, partially ready | |||||||||
| 3=Completely ready | |||||||||
| Don't know | |||||||||
| N/A | |||||||||
| C6-2 | Collecting and updating full-time employees' monthly data for Form 1095-C reporting | 1=Not at all ready | Y | Drop down, select one | Multiple Lists Group* | Employer Collecting updating |
|||
| 2= In process, partially ready | |||||||||
| 3=Completely ready | |||||||||
| Don't know | |||||||||
| N/A | |||||||||
| C7 | Have you participated in the AIR Working Group Meetings (webinars)? | Yes | C8 | Y | Radio button, one-up vertical | Skip Logic Group* | Employer Working group |
||
| No | |||||||||
| C8 | How helpful are the AIR Working Group Meetings (webinars)? | 1=Not at all helpful | C9 | Y | Radio button, one-up vertical | Skip Logic Group* | Employer Helpful working group |
||
| 2 | C9 | ||||||||
| 3 | C9 | ||||||||
| 4 | |||||||||
| 5=Very helpful | |||||||||
| N/A | |||||||||
| C9 | What suggestions do you have to improve AIR Working Group Meetings (webinars)? | N | Text area, no char limit | Skip Logic Group* | Employer Improve working group |
||||
| C10 | Are you planning on filing an extension for the 2016 mandatory filing deadline? | Yes | Y | Drop down, select one | Employer Filing extension |
||||
| No | |||||||||
| Unsure | |||||||||
| N/A | |||||||||
| C11 | What could IRS do to help you satisfy the ACA information reporting requirements? | N | Text area, no char limit | Employer Improve reporting |
|||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
© 2024 OMB.report | Privacy Policy