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Printed: 10/14/2021 Form Approved OMB No. 09380391Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
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The 1014 form approved by OMB (Office of Management and Budget) is a specific form used by certain entities to report designated information as required by federal regulations.
Entities or individuals that meet specific criteria set by federal regulations are required to file the 1014 form approved by OMB.
To fill out the 1014 form approved by OMB, one should follow the instructions provided on the form itself, which includes sections for reporting required information accurately and completely.
The purpose of the 1014 form approved by OMB is to collect data and information required by federal agencies to ensure compliance and monitor specific activities or actions.
The information that must be reported on the 1014 form includes identification details of the filer, relevant data pertaining to the reporting requirements, and any other information as specified in the form's instructions.
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