UB-04 (1679) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
60
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
16
LENGTH
7
SHORT DESCRIPTION
OTHER PROC CODE 4 (FL-74D/1)
