UB-04 (1753)    IB FORM SKELETON DEFINITION (364.6)

Name Value
BILL FORM UB-04
SECURITY LEVEL NATIONAL,NO EDIT
PAGE OR SEQUENCE 1
FIRST LINE NUMBER 63
LOCAL OVERRIDE ALLOWED YES
STARTING COLUMN OR PIECE 74
LENGTH 9
SHORT DESCRIPTION OTHER PROV ID (FL-79/1/4)