
Get the free printed: 12/28/2020 - form approved omb no. 0938-0391 - dia-hfd iowa
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PRINTED: 12/28/2020
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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What is printed 1228 - form?
Printed 1228 - form is a tax form used by businesses to report their income and expenses to the IRS.
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You must report your total income, expenses, deductions, and credits on printed 1228 - form.
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