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PRINTED: 12/09/2016 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 1209 is a form used by the department of revenue to report certain types of income or payment details for tax purposes.
Individuals or businesses that make payments subject to withholding or need to report specific income types are required to file printed 1209.
To fill out printed 1209, individuals or businesses must provide details such as taxpayer identification number, income type, payment amount, and other required information as per the instructions.
The purpose of printed 1209 is to ensure compliance with tax reporting requirements for specific payments and to assist in tax collection for the state.
The printed 1209 must report taxpayer identification information, payment amounts, dates, and types of income, among other necessary details.
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