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PRINTED: 01/17/2012 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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Printed 0117 department is for reporting miscellaneous income received throughout the tax year.
Individuals, businesses, and organizations who have received miscellaneous income over a certain threshold are required to file printed 0117 department.
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