Attachment A to UIPL No.02-03

Record Layout for the Health Insurance Tax Credit Mailout

(Not for use with 1040 regular mailouts)

Description Position

01 Blank 01 - 02

02. Primary SSN 03 - 13

03. Blank 14

04. Secondary SSN 15 - 25

05. Blank 26

06. First Name Line (left justified) 27 - 61

07. Blanks 62 - 64

08. Second Name Line or Blanks (left justified)         65 - 99

09. Blanks 100 - 102

10. Street Name 103 - 137

11. Blanks 138 - 140

12. City/State 141 - 165

13. Blank 166

14. Zip code 167 - 178

15. Blanks 179 - 180

16. Carrier Route Code 181 - 182

17. Blank 183 - 187