Form Hfs 2249 PDF Details

Form Hfs 2249 is an Illinois state tax form that must be filed by all businesses in the state with annual gross receipts of more than $500,000. The form is used to calculate the amount of tax owed on business income, and must be filed by April 15th each year. If you're not sure whether or not you need to file Hfs 2249, or if you need help completing the form, contact a professional accountant for assistance. Failing to file this form can result in significant penalties and fines, so it's important to make sure everything is done correctly.

QuestionAnswer
Form NameForm Hfs 2249
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesHFS, PAYEE, seq, unfavorable

Form Preview Example

State of Illinois

Illinois Department of Healthcare and Family Services

ADJUSTMENT (HOSPITAL)

1. DOCUMENT CONTROL NUMBER (Dept Use Only)

AAH

2. PROVIDER NAME, ADDRESS, CITY,STATE, ZIP

61

3.PAYEE NUMBER

4.PROVIDER NUMBER

5.PROVIDER NPI NUMBER

ADJUSTMENT TO

6.VOUCHER NUMBER

7.DOCUMENT CONTROL NUMBER

8. COS 9. DATE OF SERVICE

10. PROVIDER REFERENCE NUMBER

11.RECIPIENT NAME (FIRST, MI, LAST)

12.RECIPIENT NUMBER

13.DATE OF BIRTH

FOR PROVIDER USE ONLY

14. REASON ADJUSTMENT REQUESTED

Completion Mandatory, 305 ILCS 5/1-1 et seq. Failure to This is to certify that the information above is true, accurate and complete complete may result in the department taking unfavorable

action. Form has been approved by the Forms Management Center.

 

 

 

 

 

 

15. PROVIDER SIGNATURE

 

 

16. DATE

 

 

 

 

 

 

 

 

 

 

 

 

FOR ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

 

 

 

 

 

 

 

17. PROCESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TYPE

18. CAT SERVICE

19. CREDIT AMT

20. DEBIT AMT

21. REASON CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22. REASON ADJUSTMENT MADE OR DENIED

 

 

23. EMPLOYEE

 

 

24. DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25. AUTHORIZED HFS SIGNATURE

HFS 2249 (R-8-11)

How to Edit Form Hfs 2249 Online for Free

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1. Begin completing the hfs 2249 form with a group of necessary blanks. Gather all of the required information and make certain not a single thing omitted!

How to complete Illinois part 1

2. After filling in this section, go on to the subsequent step and fill in the essential particulars in these fields - REASON ADJUSTMENT REQUESTED, Completion Mandatory ILCS et seq, This is to certify that the, FOR ILLINOIS DEPARTMENT OF, PROCESS TYPE, CAT SERVICE, CREDIT AMT, DEBIT AMT, REASON CODE, PROVIDER SIGNATURE, DATE, REASON ADJUSTMENT MADE OR DENIED, EMPLOYEE, DATE, and HFS R.

Step number 2 in filling in Illinois

You can potentially make errors when completing the This is to certify that the, thus make sure that you take a second look before you finalize the form.

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