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PRINTED: 05/21/2020 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 printed 0103 form is typically associated with specific tax filings or reports required by a department, often related to state or federal taxation.
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Individuals or entities that meet certain income thresholds or are engaged in specific business activities are generally required to file the printed 0103 form as mandated by the relevant tax authority.
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