Get the free 08/25/2021 form approved - NC DHHS

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PRINTED: 08/25/2021 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 0825 form approved is a tax form used for reporting income, deductions, and credits.

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You must report all sources of income, deductions, and credits on the 0825 form approved.

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