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PRINTED: 01/09/2023 DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 09380391STATEMENT OF DEFICIENCIES AND(X1) PROVIDER/SUPPLIER/CHAPMAN OF CORRECTIONSIDENTIFICATION
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Form statements are made on IRS Form 1099.
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The purpose of form statements made on is to report payments made to contractors or vendors to the IRS for tax purposes.
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