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01/22/2020PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION
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The printed 0122 form is a tax document used by the Department of Revenue for reporting specific income and tax information.
Individuals or entities that have received income subject to reporting requirements must file the printed 0122 form.
To fill out the printed 0122 form, provide your personal information, the details of the income received, calculate the total tax owed, and sign the document.
The purpose of the printed 0122 form is to ensure accurate reporting of income and payment of taxes to the Department of Revenue.
The printed 0122 form requires reporting income amount, tax identification numbers, filing status, and any deductions or credits applicable.
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