Get Dfa Bu 3 Form

The Dfa Bu 3 Form is essential for applying for burial benefits from the West Virginia Department of Health and Human Resources. This guide will provide you with clear, step-by-step instructions on how to complete the form online, ensuring that you accurately provide all required information.

Follow the steps to navigate and complete the Dfa Bu 3 Form online:

1. Click ‘Get Form’ button to obtain the Dfa Bu 3 Form and open it in the editor.
2. Begin with section A by entering the applicant’s name, address, city, state, and zip code, along with the phone number. Make sure all information is accurate.
3. In section B, provide the deceased’s name, source of income, any Department of Health and Human Resources benefits received, address, city, state, zip code, date of death, birth date, and social security number.
4. Answer the residency question regarding the deceased’s status in West Virginia at the time of death. If the answer is 'No', add an explanation.
5. In section C, indicate your relationship to the deceased by checking the appropriate box.
6. If applicable, in section D, specify if you are another relative, a friend, an heir, or another role by checking the corresponding box.
7. Section E requires you to attest the status of the deceased's estate and whether they had sufficient resources for burial costs. Choose the correct statement.
8. In section F, disclose and list any resources that will contribute to the burial costs. You may specify additional resources if necessary.
9. Calculate and enter the total in section G for the resources listed.
10. If multiple burials are involved, indicate agreement or disagreement in section H.
11. Provide your signature and date in the designated fields, confirming understanding of the responsibilities outlined in the form.
12. Review all filled sections for accuracy and completeness before saving changes, downloading, printing, or sharing the form.

Complete your Dfa Bu 3 Form online today to ensure timely submission for burial benefits.