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CENTERS FOR MEDICARE AND MEDICAID SERVICES SPECIAL TERMS AND CONDITIONS NUMBER:11W 00296/5TITLE:Healthy Indiana Plan (HIP) 2.0AWARDEE:Indiana Family and Social Services Administration. Preface following
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Start by gathering all the necessary information and documents required to complete form 11-w-002965. This may include your personal details, income information, and any relevant tax documentation.
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11-w-002965 is a form used by individuals to report certain types of income.
Individuals who have received income that needs to be reported on this form are required to file 11-w-002965.
To fill out 11-w-002965, individuals must provide their personal information, details of the income received, and any withholding amounts.
The purpose of 11-w-002965 is to report income and taxes withheld to the IRS.
Information such as name, address, Social Security number, income source, and withholding amounts must be reported on 11-w-002965.
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