WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES Application for Burial Benefits A. Applicants Name Address City, State, Zip Phone B. Deceaseds Name Source of Income DHHR Benefits Received Address.
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How to fill out the Application For Burial Benefits - WV DHHR - Wvdhhr online
This guide provides users with clear and supportive instructions on how to fill out the Application for Burial Benefits through the West Virginia Department of Health and Human Resources. By following these steps, users can efficiently complete the application and ensure they have all the necessary information ready.
Follow the steps to effectively complete the application.
- Press the ‘Get Form’ button to access the application and open it in your desired editing format.
- Begin by entering your personal information in section A. Include your name, address, city, state, zip code, and phone number.
- In section B, provide details about the deceased. Fill in their name, source of income, any DHHR benefits received, address, city, state, zip code, date of death, birthdate, and Social Security number.
- Answer the question regarding the deceased’s residency in West Virginia at the time of death by selecting yes, no, or unknown. If you select no, explain the reason for their burial in West Virginia.
- In section C, specify your relationship to the deceased by checking the appropriate box. Options include spouse, son or daughter, father, mother, brother or sister, other relative, friend, or heir.
- Indicate your need for payment of burial costs. This is done by affirmatively stating whether the deceased's estate had sufficient resources or if you have no knowledge about the estate.
- In section E, declare the status of the heirs of the deceased. You must confirm if the deceased has no heirs, if no heirs have been located, or if you have no knowledge about the heirs.
- In section F, list any resources that will be used to cover burial costs, such as insurance benefits, Social Security, or contributions from friends and relatives. Specify if no resources are available.
- Complete the TOTAL section by summarizing the amounts listed for each resource provided.
- If applicable, indicate if more than one body will be placed in a single casket and confirm agreement. Ensure the Funeral Home Director is informed.
- Review the acknowledgment statements and confirm your understanding by checking yes or no for each statement presented concerning your liability and potential reimbursement.
- Finalize the application by signing and dating the form in the designated signature area. Ensure that all information is accurate.
- After completing the application, users can save their changes, download, print the document, or share it as needed.
Begin filling out your application for burial benefits online today to ensure timely processing.
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Get answers to your most pressing questions about US Legal Forms API.
How do I claim burial benefits?
Duly accomplished Application Form for Funeral Benefit. Death Certificate of member issued by LCR OR PSA. If claimant is not a GSIS member, Birth Certificate issued by LCR or PSA or two valid government issued IDs with date of birth and signature. Death Certificate of legal spouse issued by LCR OR PSA if married.
How do I claim the $255 Social Security death benefit?
You can apply for benefits by calling our national toll-free service at 1-800-772-1213 (TTY 1-800-325-0778) or by visiting your local Social Security office. An appointment is not required, but if you call ahead and schedule one, it may reduce the time you spend waiting to apply.
Will the state of WV pay for cremation?
(b) The Department of Health and Human Resources shall pay for direct cremation or direct burial for indigent persons in an amount not to exceed the actual cost of the direct cremation or direct burial service provided, or $1000 whichever is less.
Why does Social Security only pay $255 for burial?
In 1954, Congress decided that this was an appropriate level for the maximum LSDB benefit, and so the cap of $255 was imposed at that time.
What is the time limit for filing VA burial benefits?
Is there a time limit for filing? You must file a claim for a non-service-connected burial allowance within 2 years after the Veteran's burial. If a Veteran's discharge was changed after death from dishonorable to another status, you must file for an allowance claim within 2 years after the discharge update.
Does Social Security give you money for burial?
If you (or your spouse) own life insurance polices or have other burial arrangements in addition to your $1,500 burial funds, some of the money in the burial fund may count toward the resource limit of $2,000 for an individual or $3,000 for a couple.
What is burial assistance program West Virginia?
The burial assistance program assists with payment up to $1000 toward the cost of funeral expenses for an indigent adult or child. The program benefits are determined by the burial rate and, when applicable, the amount which exceeds the maximum allowable.
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