UB-04 (1693)    IB FORM SKELETON DEFINITION (364.6)

Name Value
BILL FORM UB-04
SECURITY LEVEL NATIONAL,NO EDIT
PAGE OR SEQUENCE 1
FIRST LINE NUMBER 55
LOCAL OVERRIDE ALLOWED YES
STARTING COLUMN OR PIECE 17
LENGTH 1
SHORT DESCRIPTION OTHER DIAG 10 POA (FL-67J/1/2)