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FORM REQUIRED BY YOUR PROVIDERPLEASE PRINT Office Use Only: S / V / N / C EHR Entered Date: SEC: NAMEBIRTHDATETODAYS DATE Nickname: Primary Care Provider and Facility: Name of Referring Provider and
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The form required is the Form 1040, Individual Income Tax Return.
Individuals who have income which exceeds a certain threshold are required to file Form 1040.
Form 1040 can be filled out manually or electronically using tax software. It requires providing information about income, deductions, credits, and tax payments.
The purpose of Form 1040 is to report individual's income, calculate tax liability, and determine if a refund is due or additional tax is owed.
Information such as income from wages, investments, self-employment, deductions, credits, and tax payments must be reported on Form 1040.
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