If this application is for burial services, it must be received by the MDHHS office in the applicant's area no later than 10 business days after the burial, cremation or donation takes place.
Verifications: the applicant has eight calendar days to provide all verifications requested.
Fuel: payment for deliverable fuel will not be made if, at the time of delivery, it is confirmed you have more than 25 percent of fuel remaining in your tank.
Hearing: you have the right to a hearing if you believe any action of the department is incorrect or the decision on your application is not made within 10 days.
Hearing request: it must be in writing, signed by you or your authorized representative, and received within 90 days following the date of this form.
| Question | Answer |
|---|---|
| Form Name | DHS-1514 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 368 |
| Avg. time to fill out | 60+ min |
| Edition | 9-18 |
| Issuing agency | Michigan Department of Health and Human Services |
| Who signs | The applicant or authorized representative |
| Previous edition | Obsolete |
| Other names | DHS-1514, DHS 1514, DHS1514, Michigan DHS-1514, MDHHS DHS-1514, Application for State Emergency Relief, SER application |
| Official source | DHS-1514 (Rev 9-18), Michigan Department of Health and Human Services |
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