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11/29/2018PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION
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Printed 1128 is a tax form used by entities to make a specific election or change in their tax treatment under the Internal Revenue Code.
Any eligible entity that wishes to make an election or change its tax classification must file printed 1128.
To fill out printed 1128, provide information about the entity, including its name, address, the type of election being made, and any required signatures.
The purpose of printed 1128 is to allow entities to elect or change their tax classification under the Internal Revenue Code.
The form requires the reporting of the entity's identifying information, the type of election being made, and any relevant supporting documentation.
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