Form 720

Step 1 of 4 - Create Form

Quarter Year*
Quarter*
EIN*
Business entity details
Autofill Default Details
- Autofill Default
Business Name*
US Address
Address Line 1*
Address Line 2
City*
State*
Zip Code*

Patient-Centered Outcomes Research Fee
Specified Health Insurance Policies
133A (With a Policy Year ending before 10/1/2022)
Amount A
Rate A
Tax A
133B (With a Policy Year ending on or after 10/1/2022 and before 10/1/2023)
Amount B
Rate B
Tax B
133A (With a Policy Year ending before 10/1/2023)
Amount A24
Rate A24
Tax A24
133B (With a Policy Year ending on or after 10/1/2023 and before 10/1/2024)
Amount B24
Rate B24
Tax B24
133A (With a Policy Year ending on or after 10/1/2023 and before 10/1/2025)
Amount A25
Rate A25
Tax A25
133B (With a Policy Year ending on or after 10/1/2023 and before 10/1/2025)
Amount B25
Rate B25
Tax B25
Applicable self-insured health plans
133C ( With a Policy Year ending before 10/1/2022)
Amount C
Rate C
Tax C
133D ( With a Policy Year ending on or afte 10/1/2022 and before 10/1/2023)
Amount D
Rate D
Tax D
133C (With a Policy Year ending before 10/1/2023)
Amount C24
Rate C24
Tax C24
133D (With a Policy Year ending on or after 10/1/2023 and before 10/1/2024)
Amount D24
Rate D24
Tax D24
133C (With a Policy Year ending on or after 10/1/2023 and before 10/1/2025)
Amount C25
Rate C25
Tax C25
133D (With a Policy Year ending on or after 10/1/2023 and before 10/1/2025)
Amount D25
Rate D25
Tax D25
41 Sport Fishing Equipment
Amount 41
Rate 41
Tax 41
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10% of sales price 41
110 Fishing Rods
Amount 110
Rate 110
Tax 110
This field is hidden when viewing the form
10% of sales price 110
42 Electric Outboard Motors
Amount 42
Rate 42
Tax 42
This field is hidden when viewing the form
3% of sales price 42
114 Fishing Tackle Boxes
Amount 114
Rate 114
Tax 114
This field is hidden when viewing the form
3% of sales price 114
44 Bows, quivers, broadheads and points
Amount 44
Rate 44
Tax 44
This field is hidden when viewing the form
11% of sales price 44
106 Arrows Shafts
Amount 106
Rate 106
Tax 106
This field is hidden when viewing the form
Shafts * $.59 106
140 Indoor Tanning Services
Amount 140
Rate 140
Tax 140
This field is hidden when viewing the form
Amount Paid * 10% 140
64 Inland waterways fuel use tax
Amount 64
Rate 64
Tax 64
This field is hidden when viewing the form
Gallons * $.29 64
125 LUST tax on inland waterways fuel use
Amount 125
Rate 125
Tax 125
This field is hidden when viewing the form
Gallons * $.001 125
51 Section 40 Fuels
Tax 51
117 Biodiesel sold as but not used as fuel
Tax 117
20 Floor Stocks Tax
(Available in Quarterly Express Plus Software)
150 Repurchase of Corporate Stock
( Not Currently Available )
142 Sales of Designated Drugs during statutory periods
(Not Currently Available)
Tax Amount

Subtotal
Options
Total

Form 720

Step 1 of 4 - Create Form

Business entity details

US Address

Company

About Us