To supply additional demographic identification
| Position | Element | Name | Type | Min/Max | Repeat | |
|---|---|---|---|---|---|---|
| 1 | 127 | Reference Identification | Opt | Alphanumeric | 1/80 | AtMax 1 |
| 2 | 156 | State or Province Code | Opt | ID | 2/2 | AtMax 1 |
| 3 | 127 | Reference Identification | Rel | Alphanumeric | 1/80 | AtMax 1 |
| 4 | 156 | State or Province Code | Rel | ID | 2/2 | AtMax 1 |
| 5 | 1268 | Applicant Type Code | Opt | ID | 1/1 | AtMax 1 |
| 6 | 83 | Code For Licensing, Certification, Registration, or Accreditation Agency | Rel | ID | 1/2 | AtMax 1 |
| 7 | 26 | Country Code | Rel | ID | 2/3 | AtMax 1 |
| 8 | 819 | Language Code | Opt | ID | 2/3 | AtMax 1 |
| 9 | 546 | Status Code | Opt | ID | 2/2 | AtMax 1 |
| 10 | 19 | City Name | Opt | Alphanumeric | 2/30 | AtMax 1 |
| 11 | 397 | Color | Opt | Alphanumeric | 1/10 | AtMax 1 |
| 12 | 397 | Color | Opt | Alphanumeric | 1/10 | AtMax 1 |
| 13 | 90 | Measurement Unit Qualifier | Rel | ID | 1/1 | AtMax 1 |
| 14 | 65 | Height | Rel | Decimal | 1/8 | AtMax 1 |
| 15 | 188 | Weight Unit Code | Rel | ID | 1/1 | AtMax 1 |
| 16 | 81 | Weight | Rel | Decimal | 1/10 | AtMax 1 |
| 17 | 352 | Description | Opt | Alphanumeric | 1/80 | AtMax 1 |
| 18 | 26 | Country Code | Opt | ID | 2/3 | AtMax 1 |