To supply additional demographic identification
| Position | Element | Name | Type | Min/Max | Repeat | |
|---|---|---|---|---|---|---|
| 1 | 127 | Reference Identification | Opt | Alphanumeric | 1/30 | Exact 1 | 
| 2 | 156 | State or Province Code | Opt | ID | 2/2 | Exact 1 | 
| 3 | 127 | Reference Identification | Rel | Alphanumeric | 1/30 | Exact 1 | 
| 4 | 156 | State or Province Code | Rel | ID | 2/2 | Exact 1 | 
| 5 | 1268 | Applicant Type Code | Opt | ID | 1/1 | Exact 1 | 
| 6 | 83 | Licensing Agency Code | Rel | ID | 1/1 | Exact 1 | 
| 7 | 26 | Country Code | Rel | ID | 2/3 | Exact 1 | 
| 8 | 819 | Language Code | Opt | ID | 2/3 | Exact 1 | 
| 9 | 546 | Status Code | Opt | ID | 2/2 | Exact 1 |