LEGACY HCFA-1500 (996) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
LEGACY HCFA-1500
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
30
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
51
LENGTH
28
SHORT DESCRIPTION
ASSIGN OF BENEFITS SIG (13A)
