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PRINTED: 03/16/2020 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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What is building 04?

Building 04 is a form used to report information about a specific building or property.

Who is required to file building 04?

Property owners or individuals responsible for the maintenance of a building are required to file building 04.

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Building 04 can be filled out online or in person by providing information such as property address, square footage, and usage.

What is the purpose of building 04?

The purpose of building 04 is to ensure that buildings are in compliance with safety regulations and zoning laws.

What information must be reported on building 04?

Information such as building address, square footage, occupancy type, and any recent renovations or improvements must be reported on building 04.

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