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PRINTED: 10/05/2011 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 1005 form approved is a tax form used by individuals to report miscellaneous income to the IRS.
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The purpose of the printed 1005 form approved is to report miscellaneous income to the IRS in order to ensure accurate tax filing.
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