QSS- Attachment 1: Questionnaire Form Matrix

QSS - Questionnaire Matrix
Form Type	NAICS	Type of respondent	Tax Status	Content
QSS‑0A	72111, 72112	Company respondents	Taxable	Revenue, source of revenue
QSS‑0E	72111, 72112	Employer Identification Number (EIN) respondents	Taxable	Revenue, source of revenue
QSS‑1A	51, 54, 5611, 5612, 56131, 56132, 5614, 5615, 5616, 5617, 5619, 562	Company respondents	Taxable	Revenue, source of revenue
QSS‑1E	51, 54, 5611, 5612, 56131, 56132, 5614, 5615, 5616, 5617, 5619, 562	Employer Identification Number (EIN) respondents	Taxable	Revenue, source of revenue
QSS-1PA	56133	Company respondents	Taxable	Revenue, source of revenue
QSS-1PE	56133	Employer Identification Number (EIN) respondents	Taxable	Revenue, source of revenue
QSS‑2A	622	Company respondents	Taxable and Tax-Exempt	Revenue, expenses, inpatient and discharge days
QSS‑2E	622	Employer Identification Number (EIN) respondents	Taxable and Tax-Exempt	Revenue, expenses, inpatient and discharge days
QSS‑3A	61, 621, 623, 624	Company respondents	Taxable and Tax-Exempt	Revenue, expenses
QSS‑3A	7111, 7113, 712, 7139, 813	Company respondents	Tax-Exempt	Revenue, expenses
QSS‑3E	61, 621, 623, 624	Employer Identification Number (EIN) respondents	Taxable and Tax-Exempt	Revenue, expenses
QSS‑3E	7111, 7113, 712, 7139, 813	Employer Identification Number (EIN) respondents	Tax-Exempt	Revenue, expenses
QSS-3SA	61, 621, 623, 624 - ONLY cases requiring company-specific instructions	Company respondents	Taxable and Tax-Exempt	Revenue, expenses
QSS-3SA	7111, 7113, 712, 7139, 813 - ONLY cases requiring company-specific instructions	Company respondents	Tax-Exempt	Revenue, expenses
QSS-3SE	61, 621, 623, 624 - ONLY cases requiring company-specific instructions	Employer Identification Number (EIN) respondents	Taxable and Tax-Exempt	Revenue, expenses
QSS-3SE	7111, 7113, 712, 7139, 813 - ONLY cases requiring company-specific instructions	Employer Identification Number (EIN) respondents	Tax-Exempt	Revenue, expenses
QSS‑4A	22, 48, 49, 53, 7113, 7114, 7115, 712, 7132, 7139, 811, 812	Company respondents	Taxable	Revenue
QSS‑4E	22, 48, 49, 53, 7113, 7114, 7115, 712, 7132, 7139, 811, 812	Employer Identification Number (EIN) respondents	Taxable	Revenue
QSS-4FA	521, 5232, 524	Company respondents	Taxable	Revenue
QSS-4FE	521, 5232, 524	Employer Identification Number (EIN) respondents	Taxable	Revenue
QSS-4SA	22, 48, 49, 51, 53, 54, 56, 7113, 7114, 7115, 712, 7132, 7139, 811, 812 - ONLY cases requiring company-specific instructions	Company respondents	Taxable	Revenue
QSS-4SE	22, 48, 49, 51, 53, 54, 56, 7113, 7114, 7115, 712, 7132, 7139, 811, 812 - ONLY cases requiring company-specific instructions	Employer Identification Number (EIN) respondents	Taxable	Revenue
QSS‑5A	7111, 7112, 7131	Company respondents	Taxable	Revenue, source of revenue
QSS‑5E	7111, 7112, 7131	Employer Identification Number (EIN) respondents	Taxable	Revenue, source of revenue
QSS‑6A	522	Company respondents	Taxable	Revenue, source of revenue
QSS‑6E	522	Employer Identification Number (EIN) respondents	Taxable	Revenue, source of revenue
QSS‑7A	5231	Company respondents	Taxable	Revenue, source of revenue
QSS‑7E	5231	Employer Identification Number (EIN) respondents	Taxable	Revenue, source of revenue
QSS‑8A	5239	Company respondents	Taxable	Revenue, source of revenue
QSS‑8E	5239	Employer Identification Number (EIN) respondents	Taxable	Revenue, source of revenue
QSS‑9A	72119, 7212, 7213	Company respondents	Taxable	Revenue
QSS‑9E	72119, 7212, 7213	Employer Identification Number (EIN) respondents	Taxable	Revenue
QSS-L5	All NAICS	Company respondents and Employer Identification Number (EIN) respondents	Taxable and Tax-Exempt	Front page only, provides username and password for online reporting