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0912 FORM CMS339 1102.3 (Cont.) EXHIBIT 1 FORM APPROVED OMB NO. 09380301 This questionnaire is required under the authority of sections 1815(a) and 1833(e) of the Social Security Act. Failure to submit
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Rev 7 09-12 form is a tax form used to report certain information to the IRS.
Individuals or entities that meet the criteria set by the IRS are required to file rev 7 09-12 form.
Rev 7 09-12 form can be filled out manually or electronically following the instructions provided by the IRS.
The purpose of rev 7 09-12 form is to report specific information to the IRS for tax compliance purposes.
Details such as income, deductions, credits, and other relevant tax information must be reported on rev 7 09-12 form.
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