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ATTACHMENT 4.19D Page 1 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT STATE: ARIZONA METHODS AND STANDARDS FOR ESTABLISHING FEEFORSERVICE PAYMENT RATES FOR LONG TERM CARE FACILITIES I. General
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Attachment 419-d page 1 is a specific form used for reporting certain information to the IRS.
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The purpose of attachment 419-d page 1 is to report specific information to the IRS for tax or regulatory purposes.
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On attachment 419-d page 1, information such as income, expenses, and other relevant financial data must be reported.
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