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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:11/27/2013FORM
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Printed 1021 refers to a specific form used by the department of revenue for reporting certain types of financial information for tax purposes.
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Businesses and individuals with financial transactions that meet certain thresholds must file printed 1021.
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Information that must be reported includes transaction dates, amounts, the nature of transactions, and any taxpayer identification information.
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