UB-04 (1572) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
5
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
62
LENGTH
6
SHORT DESCRIPTION
STATEMENT FROM DATE (FL-6A)
