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Thomas' eligibility. The household will consist of Mary, Thomas and Mary's three remaining minor children. $1000.00 - Mary's net income received in 30 days preceding death. _- 917.92 - Medically needy income level for h/h of 5 $82.08 - Countable Assets Because the countable assets of Ms. Jenkins are less than $800, she is eligible for Burial Assistance for Thomas.

The following types of income and assets are not considered:

• individual retirement accounts; • life insurance policies other than benefits already received by a financially responsible relative due to the death of the applicant; • trust funds, when not available to the deceased person or his/her financially responsible relative prior to the funeral; • vehicles; • real property; or • any other asset not immediately accessible prior to the funeral.

PROCESSING APPLICATIONS 1.5

Who May Apply 1.5.1 An applicant for burial assistance must be a relative of the deceased, or a person authorized to act on behalf of the relative of the deceased. IMA would prefer the relative applying be the next-of-kin such as a spouse or a parent if the deceased was a minor child. If the deceased was neither married nor a minor child, the next-of-kin would include parents or siblings. A relative other than the next-of-kin is permitted to apply; however, that relative must have information about the circumstances of the deceased's spouse (if married) or parent (if a minor child) and must have authority to make funeral arrangements on behalf of the deceased.

An authorized representative must be at least eighteen (18) years of age and have sufficient knowledge of the circumstances of the death to provide the required information, or be a person with legal authorization to act on behalf of the applicant. In addition an authorized representative must provide a written statement from the applicant naming him/her as the authorized representative and stating why the applicant cannot attend an interview in person.

The application must be submitted prior to the release of the body to a funeral home, unless the funeral home is under contract to provide Burial Assistance services. If the body of the deceased person is released to a contractual funeral home, the application must be filed prior to receipt of burial or cremation services.

Application Form 1.5.2 To apply, the relative, or his/her authorized representative, must fill out the Burial Assistance Application form. This form requires information about the financial circumstances of the deceased and financially responsible relatives of the deceased — namely, spouses and, in the case of minor children, parents.