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Field Name Length of Field Position of Field Contents
Confirmation Title Line #1
Text
25
1-24
“Confirmation
report for “
Filler
1
25
Reporter Name 10
26-35
Date File Received
8
36-43
Confirmation Title Line #2
Text
4
1-4
“WCBN”
Filler
8
5-12
Text
4
13-16
“UIAN”
Filler
4
17-20
Text
4
21-24
“NAME”
Filler
14
25-38
Text
3
39-41
“SSN”
Filler
7
42-48
Text
8
49-56
“Inj
Date”
Filler
13
57-69
Text
9
70-78
“Ins.
File”
Confirmation Data Record
WCBN 8
1-8
Filler 1
9
UIAN 10
10-19
Filler 1
20
Name
15
21-35
Filler
1
36
SSN
10
37-47
Filler
1
48
Injury Date 10
49-58
Filler
1
59
Text
9
60-68
“Add”
or “Corrected”
Filler
1
69
Insurer File Number 15
70-84