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PRINTED: 11/04/2016 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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The 15g384 1028 is a form used for tax purposes, specifically related to the reporting of income that may be subject to withholding.
Individuals or entities that receive certain types of income, which might be exempt from withholding, are required to file the 15g384 1028.
To fill out the 15g384 1028, one needs to provide personal information, details about the income, and any exemptions being claimed.
The purpose of the 15g384 1028 is to certify that the income received is not subject to withholding tax based on certain exemptions.
Information required includes the taxpayer's name, address, taxpayer identification number, amount of income, and reasons for claiming exemption.
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