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PRINTED: 12/23/2020 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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Printed 1223 - form is a tax form used to report certain income, deductions, and credits.

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Printed 1223 - form requires information such as income earned, deductions claimed, and credits eligible for tax relief.

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