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West Virginia Income Maintenance Manual Chapter 20

West Virginia Income Maintenance Manual Page 38 Chapter 20 Emergency and Special Assistance Programs

an accompanying letter of instructions that include a deadline for returning the completed application through the mail. The instructions will also request a copy of the death certificate and the deceased's Social Security Number if not included on the certificate. After the application is received through the mail, the Worker will carefully review the completed application form and make a decision regarding eligibility or request the applicant to supply additional information. The following instructions must be followed when completing Form DFA-BU-1: • Section A and B, Identifying Information: The required identifying information in these two sections is self-explanatory. If the deceased was a non-resident of West Virginia at the time of death, the applicant must explain why the deceased is to be buried in West Virginia. This explanation is needed in order to assure that family and relatives have been notified and are aware that the deceased will be buried in West Virginia. • Section C, Your Relationship to the Deceased: If the applicant indicates that he is a child, parents or siblings of the deceased (responsible relative), he must complete Form DFA-BU-2, Affidavit of Responsible Relative. If the applicant indicates that he is not a liable relative, he will be requested to complete Form DFA-BU-2 for the purpose of developing potential resources. A funeral home that is applying on behalf of the deceased does not need to complete the DFA-BU-2. • Section D Need and Estate of the Deceased: The applicant must place an "X" on the line next to the statement which indicates his knowledge of whether the deceased's estate had sufficient resources equal to the maximum allowable payment. When the applicant indicates the estate has at least $2,200 in resources to pay for the burial costs, the case will be found ineligible for a burial assistance. • Section E, Heirs of the Deceased: The applicant must complete this section which involves questions about the heirs of the deceased. An Heir is a person legally entitled to the property of another on that person’s death. • Section F, Resources: The applicant must indicate the type and amount of resources received or to be received toward the burial expenses. It will be the responsibility of the applicant to report this accurately and completely. It may be necessary for the applicant to contact the Funeral Home Director regarding this item to ensure accuracy. Finally, the Worker should inform the applicant that the DFA-67-A, Burial Billing Form, submitted by the Funeral Home Director will be compared with Section F for discrepancies. • Section G, Multiple Burials: The applicant must read the statement regarding the policy on multiple burials and place an “X” in “I Agree”, or “I Do Not Agree”, or “Not Applicable”. • Section H, Signatures: The applicant must read each of the three statements and place an "X" in "Yes" or "No" prior to signing and dating the application form. The Worker should ask the applicant if he understands each of the three statements and verbally explain any of the statements that the applicant does not understand.