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Printed: 12/10/2024 Form Approved OMB No. 09380391Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CLIA
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The 1204 form is a tax form used for reporting specific financial information to the IRS and is approved for use in certain tax situations.
Organizations or individuals that meet the criteria specified by the IRS, typically related to certain tax obligations or financial disclosures, are required to file the 1204 form.
To fill out the 1204 form, gather the necessary financial information, follow the instructions provided by the IRS, and accurately complete each section of the form before submitting it.
The purpose of the 1204 form is to provide the IRS with essential information regarding an entity's financial activities, helping ensure compliance with tax regulations.
The 1204 form requires reporting of financial details such as income, expenses, deductions, and any other relevant financial transactions as specified by the IRS.
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