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04/19/2021PRINTED: 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 0419 is a form used by the Department of Revenue for reporting certain types of income or financial information.
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Individuals and businesses that meet specific income thresholds or financial criteria as specified by the Department of Revenue are required to file printed 0419.
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