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PRINTED: 06/09/2014 FORM APPROVED DEPARTMENT 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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CI - 0128 is a form used for reporting income and expenses for tax purposes.
Any individual or business entity with income or expenses that meet certain thresholds is required to file CI - 0128.
CI - 0128 can be filled out by providing accurate information about income and expenses in the designated sections of the form.
The purpose of CI - 0128 is to report income and expenses to the tax authorities.
Information such as income sources, expense categories, and totals must be reported on CI - 0128.
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