Pennsylvania Code
Title 55 - HUMAN SERVICES
Part II - Public Assistance Manual
Subpart I - Other Income Maintenance Programs
Chapter 283 - PAYMENT FOR BURIAL AND CREMATION
REQUIREMENTS
Section 283.6 - Submission of form for payment
Universal Citation: 55 PA Code ยง 283.6
Current through Register Vol. 54, No. 44, November 2, 2024
(a) The individual requesting payment or the funeral director on behalf of the individual requesting payment shall submit the request on a form approved by the Department in accordance with § 283.7 (relating to date of request for payment). This form is available from the Department or a funeral director enrolled as a provider with the Department.
(b) The form shall be completed by the individual requesting payment and the funeral director. The form must include the following information:
(1) Name and Social
Security number of the deceased.
(2) Name and signature of the representative
requesting payment on behalf of the deceased.
(3) Resources available towards
payment.
(4) Name and address of
the funeral home.
(5) Name and
signature of the funeral director providing goods and services for burial or
cremation, or both.
This section cited in 55 Pa. Code § 283.3 (relating to requirements for payment).
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