UB-04 (1674) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
58
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
25
LENGTH
6
SHORT DESCRIPTION
OTHER PROC DATE 1 (FL-74A/1)
