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PRINTED: 03/29/2016 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 0329 is a specific form used by the Department of Finance for reporting certain financial information.

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Information such as total income, deductions, tax credits, and other pertinent financial data must be reported on printed 0329.

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