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Form ASC-130 Instructions

Ambulatory Surgical Centers (ASC) must use Form ASC‑130, Ambulatory Surgical Center Gross Receipts Tax Return, to electronically file and pay the quarterly gross receipts tax.

Gross receipts means the entire amount the entity received from all sources during the calendar quarter, without subtracting any costs or expenses. Gross receipts shall be calculated on a cash basis.

The tax shall not be imposed on:

  • The first million dollars of gross receipts of the ASC in the applicable fiscal year (July 1 through June 30); or
  • The net patient revenue of a hospital that is subject to the tax imposed under Chapter 211a of the Connecticut General Statutes.

Required information: Enter the calendar quarter, the ASC's Connecticut Tax Registration Number, FEIN, and Connecticut Department of Public Health ASC License Number in the spaces provided.

If you are amending a prior return, check the Amended Return box on the return.

Due Date: Form ASC‑130 is due on or before the last day of April, July, October, and January for the preceding calendar quarter even if no tax is due. If the due date falls on a Saturday, Sunday or legal holiday, the return will be considered timely if filed by the next business day.

Visit to use the Taxpayer Service Center (TSC) to make a direct tax payment. Using this option authorizes DRS to electronically withdraw a payment from your bank account (checking or savings) on a date you select up to the due date.

Electronic Filing Waiver: Only taxpayers that receive a waiver from electronic filing from DRS may file a paper version of this form. To request a waiver from the electronic filing requirement visit and complete Form DRS-EWVR, Electronic Filing and Payment Waiver Request.

Rounding Off to Whole Dollars: You must round off cents to the nearest whole dollar on your return and schedules. If you do not round, DRS will disregard the cents. Round down to the next lowest dollar all amounts that include 1 through 49 cents. Round up to the next highest dollar all amounts that include 50 through 99 cents.

Line instructions

Line 1: Enter the entire amount of gross receipts from all sources for the calendar quarter less Medicare and Medicaid payments.

Line 2a: Enter the amount reported on Line 2d of your previous quarter's tax return. Enter zero ("0") if this return is the first quarterly return in the fiscal year.

Line 2b: Subtract the amount on Line 2a from $1,000,000. Enter result.

Line 2c: Enter the lesser of the amount on Line 1 or the amount on Line 2b.

Line 2d: Add Line 2a and Line 2c. Enter result.

Line 2e: Enter the amount of gross receipts from Line 1 subject to the second Hospital User Fee.

Line 2: Add amount on Line 2c and amount on Line 2e. Enter result.

Line 3: Subtract the amount on Line 2 from the amount on Line 1. If the result is zero or less, enter "0".

Line 4: Tax due: Multiply Line 3 by 6% (.06). Enter result.

Line 5: Reserved for future use.

Line 6: Reserved for future use.

Line 7: Interest and Penalty

Interest: In general, interest applies to any portion of the tax not paid on or before the original due date of the return. If you do not pay the tax when due, you will owe interest at the rate of 1% (.01) per month or fraction of a month until the tax is paid in full.

Penalty for Failure to Pay Tax When Due: 10% (.10) of the tax due or $50, whichever is greater.

Line 8: Add the amount on Line 4 and the amount on Line 7, and enter the total amount due.