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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICESForm Approved OMB No. 09380062INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIESSURVEY REPORT1.
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In the county field, enter the name of the county where the event or action took place.
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What is city and/or county?
City and/or county refers to the local government jurisdiction where a person or business is located.
Who is required to file city and/or county?
Individuals and businesses located within a city and/or county are required to file.
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City and/or county forms can typically be filled out online or submitted in person at the local government office.
What is the purpose of city and/or county?
The purpose of city and/or county filing is to report local taxes, fees, or regulations that may apply to individuals or businesses within that jurisdiction.
What information must be reported on city and/or county?
Information such as income, property ownership, business activities, and other relevant data may need to be reported on city and/or county forms.
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