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PRINTED: 04/14/2023 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION
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The 0414 form is a specific document required for reporting certain financial information to regulatory authorities, typically relating to foreign assets or income.
Individuals and entities that possess foreign financial accounts or assets above a certain threshold are required to file the 0414 form.
To fill out the 0414 form, you need to provide detailed information about your foreign financial accounts, including account numbers, bank names, and the maximum value of each account during the reporting year.
The purpose of the 0414 form is to ensure compliance with reporting requirements on foreign financial assets and to prevent tax evasion.
The form requires reporting information such as account numbers, foreign financial institution details, types of accounts, and maximum account values.
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