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PRINTED: 03/09/2023 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 1214 form, also known as the Approved Form 1214, is a document used for reporting specific information to the relevant authorities, often related to tax or financial disclosures.

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Individuals or entities that meet certain criteria set by the governing body, typically involving income levels or business operations, are required to file the 1214 form.

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The 1214 form must report detailed information such as personal identification, financial details, sources of income, and any other relevant data as required by the filing authority.

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