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PRINTED: 11/06/2014 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 Form 1114, also known as the Report of Foreign Bank and Financial Accounts (FBAR), is used to report foreign bank accounts and financial accounts held by U.S. persons.
U.S. persons including citizens, residents, and entities are required to file Form 1114 if they have foreign financial accounts with an aggregate value exceeding $10,000 at any time during the calendar year.
To fill out Form 1114, you need to provide personal identification information, details of your foreign financial accounts, and the maximum value of those accounts during the reporting period.
The purpose of Form 1114 is to prevent tax evasion by ensuring that U.S. persons report foreign financial accounts to the U.S. government.
Form 1114 requires reporting information such as the name and address of the financial institution, the account number, the type of account, and the maximum value of the account during the year.
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