(1) Each provider must complete and file with the Department of Revenue a quarterly reporting form on or before the last day of the month following the end of each calendar quarter.

(2) The quarterly reporting form must provide the following information:

(a) ending date of the calendar quarter covered by the return being filed;

(b) name and address of the provider;

(c) total number of exempt and nonexempt end user connections for the calendar quarter;

(d) number of nonexempt end user connections for the quarter;

(e) amount of fee computed by multiplying the total number of nonexempt end user connections times ten cents per month of service during the quarter;

(f) credits for uncollectible accounts, incorrect billings, and other appropriate adjustments if the provider elects to take a credit;

(g) amounts collected in the quarter for any accounts reported as uncollectible in a previous quarter if the provider has elected to take a credit under (f);

(h) credits for 3/4 of 1% of the total charges billed and collected each month to cover administrative expenses if the provider elects to take a credit; and  

(i) the amount remitted with the return.