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PRINTED: 01/09/2023 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 0109 department is for reporting employment tax information.
Employers who have employees that they pay wages to are required to file the printed 0109 department.
Printed 0109 department can be filled out using payroll software or manually. It requires information about the employer, employee, wages paid, and taxes withheld.
The purpose of printed 0109 department is to report employment tax information to the IRS.
Information such as employer identification number, employee wages, taxes withheld, and other employment tax details must be reported on printed 0109 department.
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