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PRINTED: 11/01/2016 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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The printed 1101 form is a tax form used by the Department of Revenue.
Individuals and businesses are required to file the printed 1101 form with the Department of Revenue.
The printed 1101 form can be filled out online or submitted in paper form.
The purpose of the printed 1101 form is to report income and expenses for tax purposes.
Information such as income, expenses, deductions, and credits must be reported on the printed 1101 form.
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