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PRINTED: 01/09/2020 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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0109 form approved is a tax form used for reporting certain types of income, such as payments made to independent contractors.
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Businesses and individuals who have paid income to independent contractors or vendors are required to file 0109 form approved.
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