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PRINTED: 02/14/2017 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 0214 refers to a specific form used for departmental reporting in various contexts, typically related to tax or financial purposes.

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To fill out printed 0214, one must provide relevant financial information, including income, deductions, and any other required data as specified in the instructions accompanying the form.

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Information required on printed 0214 typically includes income details, deductions, credits, and any specific data required by the department relevant to the filing entity.

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