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PRINTED: 11/12/2020 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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Printed 1112 department is a tax form used to report miscellaneous income.
Any individual or entity that has received miscellaneous income totaling $600 or more during the tax year is required to file printed 1112 department.
Printed 1112 department should be filled out with the payer's information, recipient's information, and the amount of miscellaneous income received.
The purpose of printed 1112 department is to report miscellaneous income to the IRS for tax purposes.
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