5-HSS-26-033 - Indigent Burial - Appendix F - DSS Authorization for Indigent Burial.docx

This is an authorization form for indigent burial services issued by the Delaware Health and Social Services Division of Social Services. The form serves as documentation to process burials for individuals determined to be indigent and unable to afford funeral expenses. The form collects essential candidate information including full name, social security number, military service details if applicable, place and date of birth, and place and date of death. It also requires documentation of relatives including their relationships, names, and addresses, along with additional information necessary to locate relatives or assess the financial situation of the deceased. The form is completed by an authorized representative who provides their name, phone number, organization, and address.

This appendix functions as a supporting document within the broader procurement process for the state of Delaware's indigent burial and cremation services contract (5-HSS-26-033). The form establishes the administrative framework for determining eligibility and authorizing burial services through the Division of Social Services. By collecting standardized information about candidates for indigent burial, the form ensures consistent documentation and processing of burial authorizations that will be managed through the established vendor pool referenced in the primary contract solicitation materials.