UB-04 (1682) 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
40
LENGTH
7
SHORT DESCRIPTION
OTHER PROC DATE 5 (FL-74E/2)
