UB-04 (1668) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
51
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
58
LENGTH
25
SHORT DESCRIPTION
EMPLOYER NAME (FL-65A:C)
CALCULATE ONLY OR OUTPUT
OUTPUT
