Page 257

West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 13 Chapter 1 Application/Redetermination Process

Program and Form ID Name of Form When to Use Due Date of Additional Information Agency Time Limits OTHER DOHS ASSISTANCE PROGRAMS Burial Assistance DFA-BU-1 Application for Indigent Burial Benefits Used in taking applications for payment of burial expenses. None. The application must be completed within 30 days of interment or cremation. The completed burial packet must be sent to DFA Policy Unit within three business days of receipt.

DFA-BU-2 Affidavit of Responsible Relative Required when the applicant is a relative who is liable for the burial costs of the deceased; preferred when the applicant is a relative who is not liable for the burial costs or the applicant is not a relative of the deceased. Used to determine financial ability of those responsible relatives who are liable for the burial costs of the deceased and to determine sufficient ability of other relatives who wish to contribute to the burial costs but are not liable.

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Page 257

Official source

West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 13 Chapter 1 Application/Redetermination Process

Program and Form ID Name of Form When to Use Due Date of Additional Information Agency Time Limits OTHER DOHS ASSISTANCE PROGRAMS Burial Assistance DFA-BU-1 Application for Indigent Burial Benefits Used in taking applications for payment of burial expenses. None. The application must be completed within 30 days of interment or cremation. The completed burial packet must be sent to DFA Policy Unit within three business days of receipt.

DFA-BU-2 Affidavit of Responsible Relative Required when the applicant is a relative who is liable for the burial costs of the deceased; preferred when the applicant is a relative who is not liable for the burial costs or the applicant is not a relative of the deceased. Used to determine financial ability of those responsible relatives who are liable for the burial costs of the deceased and to determine sufficient ability of other relatives who wish to contribute to the burial costs but are not liable.