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PRINTED: 02/29/2024 FORM APPROVED Illinois Department of Public Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:GOLDWATER CARE BLOOMINGTON (X4)
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The 0416 form is used to report earnings and taxes withheld from income.
Employers are required to file the 0416 form for each employee.
You can fill out the 0416 form by entering the employee's information, earnings, and tax withheld.
The purpose of the 0416 form is to report income and tax withheld for each employee.
The 0416 form must include the employee's name, social security number, earnings, and tax withheld.
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