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PRINTED: 07/12/2012 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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To fill out Form 520 continued from, follow these steps:
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Start by entering your name, address, and contact information in the designated fields at the top of the form.
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Provide your Social Security Number or Employer Identification Number (EIN) if applicable.
04
Indicate the tax year for which the form is being filed.
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Enter the date of the original filing and the case number or other identifying information.
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In the continuation section, clearly label each line with the appropriate line number from the original form.
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Include a brief explanation or description of each entry in the continuation section.
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Calculate the total amounts for each section and enter them in the designated fields.
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Attach any supporting documents or schedules as required.
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f 520 continued from is a form typically used for reporting financial information from a previous filing period.
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Information such as income, expenses, assets, and liabilities from the previous filing period.
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