IENT NO. REQUEST FOR BURIAL AND/OR CREMATION PAYMENT: RELATIONSHIP TO DECEASED: I request the Department of Human Services to pay the burial and/or cremation expenses of: I am a Representative of a fraternal society (deceased was a member) or of a charitable or religious organization: RELATIVE TO BE FILLED IN BY PERSON MAKING REQUEST State Relationship (Give Name of Organization) FRIEND If this block is checked, this form must be accompanied by an unfit certificate from the Anatom.

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How to fill out the PA PA 118 online

The PA PA 118 form is a crucial document for requesting burial and cremation payments from the Department of Human Services. This guide provides detailed, step-by-step instructions to help users accurately complete the form online, ensuring a smooth application process.

Follow the steps to complete the PA PA 118 online effectively.

  1. Click ‘Get Form’ button to obtain the PA PA 118 and access it in your editor.
  2. Begin by filling in the county-district, record number/line number, and social security number related to the deceased. This identification is essential for processing the request.
  3. Provide the name of the deceased, date of death, date of request, and their age at the time of death. Ensure accuracy in these details, as they are critical for the application.
  4. Complete the address field for the deceased, which helps in locating relevant records.
  5. Indicate the relationship to the deceased: as a representative of an organization, relative, friend, or other. If applicable, attach the required unfit certificate if the form is submitted by a friend.
  6. List any payments you are able to contribute towards the burial or cremation expenses in the designated field, and document payments made by others as required.
  7. Detail the assets available in the deceased's estate, including insurance, savings, and property. It's vital to provide accurate amounts and descriptions.
  8. Provide your signature certifying the accuracy of the information provided, along with the date signed. This is crucial to validate your request.
  9. If applicable, complete the certification section for the executive director, including any resources that may reduce the DHS payment.
  10. Complete the invoice section as a funeral director, including specific burial or cremation charges, and ensure the certification by the funeral director is signed.
  11. Once all fields are filled accurately, you can save changes, download, print, or share the form as needed.

Take the next step in the process by completing your PA PA 118 online today.

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