IL 444-0094 2007-2024 free printable template

State of Illinois Department of Human Services FUNERAL AND BURIAL REIMBURSEMENT CLAIM CLAIMANT IDENTIFICATION 1. SSN: 3. Name, Address, Zip Code: 2. Type: COMPLETE ALL ITEMS Enter NA” if an item

How to fill out burial claim online form

How to fill out Illinois funeral burial reimbursement:

1. Gather all necessary documents such as death certificate, funeral contract, and itemized funeral expenses.
2. Access the Illinois Department of Human Services website and locate the funeral burial reimbursement application form.
3. Carefully read and understand the instructions provided on the form.
4. Fill in personal information such as name, address, Social Security number, and contact details.
5. Provide details about the deceased individual such as their name, date of birth, and date of death.
6. Attach copies of all necessary documents to support the reimbursement claim.
7. Fill in the section regarding funeral home and service provider information, including their name, address, and contact details.
8. Enter the total cost of funeral services, burial plot, transportation, and other related expenses in the appropriate sections.
9. Review the completed form for accuracy and make any necessary corrections.
10. Sign and date the application form.
11. Submit the completed form along with all supporting documents either by mail or through the online submission process.

Who needs Illinois funeral burial reimbursement:

1. Individuals who have incurred funeral and burial expenses for a deceased person may be eligible for the Illinois funeral burial reimbursement.
2. This reimbursement is particularly beneficial for low-income individuals or families who may struggle to cover the costs associated with funerals and burials.
3. Residents of Illinois who meet the eligibility criteria and have incurred qualifying expenses can apply for this reimbursement to help alleviate the financial burden of funeral costs.

For pdfFiller’s FAQs

What is illinois funeral burial reimbursement?

Illinois funeral burial reimbursement refers to a program offered by the state of Illinois that provides financial assistance to individuals or families who are unable to afford the costs associated with the burial or cremation of a loved one. The program, formally known as the Illinois Department of Human Services' Funeral and Burial Program, helps cover basic funeral and burial expenses for eligible individuals, such as the funeral service, transportation of the deceased, and burial or cremation fees. The reimbursement amount may vary depending on the applicant's financial situation and available resources.

Who is required to file illinois funeral burial reimbursement?

The person who is responsible for the funeral and burial expenses of an Illinois resident is typically required to file for funeral burial reimbursement. This could be a family member, friend, or any individual who has incurred the funeral costs. However, it is advisable to check with the Illinois Department of Human Services or consult a legal professional for specific eligibility criteria and requirements.

How to fill out illinois funeral burial reimbursement?

To fill out the Illinois Funeral Burial Reimbursement form, follow the steps below: 1. Obtain the necessary forms: Request the Illinois Funeral Burial Reimbursement form from the Illinois Department of Human Services (IDHS) or download it from their website. 2. Gather required documentation: Collect all documentation required to support your claim, including the following: - Proof of Illinois residency - Proof of relationship to the deceased (such as a marriage certificate or birth certificate) - Funeral home invoice or itemized statement of burial expenses - Death certificate - Verification of income (pay stubs, tax returns, or W-2 forms) 3. Complete the application form: Start by providing your personal information, including your name, address, Social Security number, and contact details. 4. Indicate your relationship to the deceased: Specify your relationship with the deceased person, whether you are the surviving spouse, child, parent, or other relative. 5. Provide information about the deceased: Enter the name, Social Security number (if available), date of birth, and date of death of the deceased individual. 6. Describe funeral and burial expenses: Complete the section that requires you to provide details about the funeral and burial expenses. Include the names and addresses of the funeral home and cemetery, the date of the funeral or burial, and a breakdown of the costs. 7. Indicate your income: Fill in the section that requires you to provide your income information, including the current monthly income and average monthly income for the past three months. Attach the necessary income verification documentation as specified in the instructions. 8. Attach required supporting documents: Make sure to attach copies of all the required supporting documents, including proof of residency, proof of relationship to the deceased, funeral home invoice, death certificate, and income verification. 9. Sign and date the form: Confirm that all the information provided is accurate, sign, and date the form. 10. Submit your application: Review the completed form and attachments to ensure everything is in order. Submit the form either in person or by mail to the address indicated on the form. Make sure to keep copies of all the documentation submitted for your records.

What is the purpose of illinois funeral burial reimbursement?

The purpose of Illinois Funeral Burial Reimbursement is to assist low-income individuals and families in Illinois with the financial burden of paying for funeral and burial expenses. The program provides a reimbursement of up to $1,103 to eligible applicants who meet the income and resource guidelines. It is designed to ensure that people who cannot afford proper funeral services are still able to give their loved ones a dignified burial or cremation.

What information must be reported on illinois funeral burial reimbursement?

The following information must be reported on an Illinois funeral burial reimbursement: 1. Personal information: Full name, address, and contact details of the deceased individual for whom the reimbursement is being claimed. 2. Funeral service provider information: Name, address, and contact details of the funeral home or funeral service provider that conducted the funeral/burial services. 3. Itemized expenses: A detailed breakdown of the funeral and burial expenses incurred, including the cost of casket/coffin, embalming, transportation, grave marker, burial plot, flowers, funeral service fees, etc. Each expense should be listed separately. 4. Proof of payment: Copies of all relevant documents proving that the expenses were actually paid, such as receipts, invoices, canceled checks, credit card bills, etc. It is important to include the date of payment and the method of payment for each expense. 5. Proof of eligibility: Any supporting documents that establish the claimant's eligibility for reimbursement, such as a death certificate, proof of relationship to the deceased (if applicable), and proof of residency in Illinois. 6. Application form: The completed and signed funeral burial reimbursement application form provided by the State of Illinois or the relevant local government agency. This form may require additional information specific to the reimbursement program. It is essential to review and comply with the specific requirements and guidelines of the funeral burial reimbursement program in Illinois, as they may vary based on the program and circumstances.

What is the penalty for the late filing of illinois funeral burial reimbursement?

There is currently no specific information available regarding penalties for late filing of Illinois funeral burial reimbursement. It is advised to directly contact the Illinois Department of Human Services or a qualified legal professional for accurate and up-to-date information regarding this matter.

Can I sign the burial claim online electronically in Chrome?

Yes. With pdfFiller for Chrome, you can eSign documents and utilize the PDF editor all in one spot. Create a legally enforceable eSignature by sketching, typing, or uploading a handwritten signature image. You may eSign your illinois funeral reimbursement form in seconds.

How can I edit illinois funeral and burial reimbursement claim on a smartphone?

You may do so effortlessly with pdfFiller's iOS and Android apps, which are available in the Apple Store and Google Play Store, respectively. You may also obtain the program from our website: https://edit-pdf-ios-android.pdffiller.com/. Open the application, sign in, and begin editing funeral and burial reimbursement claim form right away.

Can I edit illinois funeral burial reimbursement on an iOS device?

You can. Using the pdfFiller iOS app, you can edit, distribute, and sign funeral and burial reimbursement claim form. Install it in seconds at the Apple Store. The app is free, but you must register to buy a subscription or start a free trial.