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PRINTED: 12/14/2016 FORM APPROVEDDEPARTMENT 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 1214 department is a form used by employers to report employee wage and tax information to the state.
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The purpose of printed 1214 department is to report employee wage and tax information to the state for tax purposes.
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