Page 1671

West Virginia Income Maintenance Manual Chapter 20

West Virginia Income Maintenance Manual Page 36 Chapter 20 Emergency and Special Assistance Programs

• When the applicant is a liable relative, the DFA-BU-2 must be completed. If not, the application must be denied. • If the relative who signed the DFA-BU-2 form agrees to pay for the burial costs, the application must be denied. • If the applicant indicates in Section D of the DFA-BU-1 form that the deceased had sufficient resources to pay for the burial costs, the application must be denied. • If the applicant indicates in Section F of the DFA-BU-1 form that sufficient resources will be applied toward the burial that is equal to or exceeds $2,200, the application must be denied. After consideration is given by the Worker to the above items, he will make a decision regarding the eligibility for payment of burial costs and make a recording on the application form to support his decision. When the Indigent Burial application is denied, the Worker must send a completed DFA-BU-4 notification to the person who made application for the burial. In addition, a copy of the DFA-BU- 4 must be sent to the funeral home that provided burial services for the deceased. If the application was made by the Funeral Home Director or staff, when no relatives, friends, or other persons are available, the original DFA-BU-4 is sent to the funeral home directly. The DFA-BU-4 form is found on the Division of Family Assistance (DFA) intranet site. The reason for the denial must be stated on the notice. In addition, the Fair Hearing and/or Conference Request form, DFA-FH-1, must be included with the denial letter and sent to the applicant. A copy of the denial letter must be sent to the funeral home and a copy must be placed in the deceased’s file. 20.3.4 FORMS 20.3.4.A DFA-BU-1, Application for Burial Benefits The DFA-BU-1 is the application completed for payment of burial benefits. The DFA-BU-1 form is found on the Division of Family Assistance (DFA) intranet site. 20.3.4.B DFA-BU-2, Affidavit of Responsible Relative