Attachment 1 - Form Matrix.xlsx

Quarterly Services Survey

Attachment 1 - Form Matrix.xlsx

OMB: 0607-0907

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QSS - Questionnaire Matrix





Form Type NAICS Type of respondent Tax Status Content
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, 72111, 72112, 72119, 7212, 7213, 811, 812 Company respondents Taxable Revenue
QSS‑4E 22, 48, 49, 53, 7113, 7114, 7115, 712, 7132, 7139, 72111, 72112, 72119, 7212, 7213, 811, 812 Employer Identification Number (EIN) respondents Taxable Revenue
QSS-4FA 521, 522, 5231, 5232, 5239, 524 Company respondents Taxable Revenue
QSS-4FE 521, 522, 5231, 5232, 5239, 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
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