UB-04 (1711) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
56
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
56
LENGTH
1
SHORT DESCRIPTION
ECI POA (FL-72A/1/2)
