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PRINTED: 03/01/2023 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.

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What is printed 0628 - form?

The printed 0628 - form is a tax form used for reporting certain financial information to the IRS.

Who is required to file printed 0628 - form?

Individuals or businesses meeting certain criteria set by the IRS are required to file the printed 0628 - form.

How to fill out printed 0628 - form?

The printed 0628 - form can be filled out manually or electronically, following the instructions provided by the IRS.

What is the purpose of printed 0628 - form?

The purpose of printed 0628 - form is to report specific financial information to the IRS for tax compliance purposes.

What information must be reported on printed 0628 - form?

Information such as income, expenses, deductions, and credits must be reported on the printed 0628 - form.

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