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PRINTED: 02/18/2020 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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The printed 0218 form is a tax form used to report specific income and expenses to the tax authority, ensuring compliance with tax regulations.

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The information that must be reported includes personal identification details, sources of income, taxes withheld, and deduction claims.

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