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Get the free PRINTED: 1212312011 FORM APPROVED OMB NO. 0938 0391 - chfs ky

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PRINTED: 05/25/2012 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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The printed 1212312011 form is a tax form used for reporting certain information to the IRS.
Any individual or entity that meets the criteria set forth by the IRS for filing this form.
The form can be filled out manually or electronically, following the instructions provided by the IRS.
The purpose of the form is to report specific information to the IRS for tax purposes.
The form requires reporting of various financial and tax-related information as outlined by the IRS.
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