Item III: are any full funeral benefits available to the decedent such as but not limited to pre-paid funeral or burial plans, insurance plans, associations, and clubs?
Death certificate: if the document is available at the time you turn in this application, please attach.
Full funeral benefits: they mean funeral and/or burial services that provide a complete and dignified disposal of the decedent.
Item IV: has anyone received or expect to receive the lump-sum death payment benefit from Social Security for the decedent?
| Question | Answer |
|---|---|
| Form Name | DHS 1163 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 20 |
| Avg. time to fill out | 4 min |
| Edition | Rev 07/18 |
| Issuing agency | State of Hawaii Med-QUEST Division, Department of Human Services |
| Other names | DHS 1163, DHS-1163, DHS1163, Form DHS 1163, Death Payments Program Application, Hawaii Death Payments Program |
| Official source | DHS 1163 (Rev 07/18), State of Hawaii Med-QUEST Division, Department of Human Services |
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