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PRINTED: 11/28/2017 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 1128 department is related to the classification of entity for tax purposes.
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Entities that are seeking to change their tax classification are required to file printed form 1128.
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Printed form 1128 requires entities to provide information about the current tax classification, proposed tax classification, and reasons for the requested change.
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