| Name | Value |
|---|---|
| FORM FIELD REFERENCE | UB-04 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-GET FROM PREVIOUS EXTRACT |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | K IBXDATA |
| FORMAT CODE DESCRIPTION | FL-30 Reserved for assignment by the NUBC. Not used. 11 positions upper line. 13 positions lower line. |