Upon receipt of a valid request, the CAO will:
1. Complete three copies of the Burial Payment Request form PA 118, entering the following information on the first four lines of side one:
County and district codes.
Ten digit recipient number.
Record number followed by the line number of the deceased.
Name of deceased.
Social Security number of deceased.
Case payment name at time of death.
Address at time of death.
Age at death (in minutes, hours, days, months or years, as appropriate).
Date of death.
Date of request (date the CAO was first asked to pay for burial).
2. Mail the form to the requestor or the funeral director if the funeral director is assisting the requestor in the process.
Upon receipt of the form, the requestor will:
1. Complete and sign Section I.
NOTE: The funeral director may not make the request for payment, but may help the requestor complete the PA 118.
2. Return the request to the CAO to forward to the funeral director or give the request to the funeral director.
Upon receipt, the funeral director will:
1. Complete Side 2 of the PA 118, including the “Certification of Funeral Director” box.
2. Return the original to the CAO.
Upon receipt of the completed PA 118, the CAO will:
1. Complete Section II, “Certification of Executive Director,” including checking one box for each potential resource.
2. Attach documentation explaining the reason for any delay in filing the request.
3. Notify the requestor of eligibility or ineligibility.
4. Forward the PA 118 to OMAP for payment, if eligible.
Updated July 25, 2024, Replacing April 16, 2021