(a) A disbursement request shall include: (1) the name and address of the eligible survivor and his or her relationship to the child victim; (2) the date and nature of the crime on which the disbursement request is based; (3) the nature and extent of the injuries sustained by the child victim, and the names and addresses of those giving any medical and hospitalization treatment to the child victim; (4) a copy of the child victim's death certificate; (5) an affidavit of facts of death; (6) documentation verifying an eligible survivor's household income; (7) a copy of the invoice detailing funeral and burial expenses, including any applicable taxes, surcharges, and fees; (8) releases authorizing the surrender to the Department of reports, documents and other information relating to matters specified under this Act and rules adopted in accordance with this Act; and (9) such other information as the Department reasonably requires. (b) The Department may require that materials substantiating the facts stated in the disbursement request be submitted with that request. (c) A funeral establishment or cemetery authority, on its own volition, may file an amended request or additional substantiating materials to correct inadvertent errors or omissions at any time before the original request has been disposed of by the Department. In either case, the filing of additional information or of an amended request shall be considered for the purpose of this Act to have been filed at the same time as the original request. his or her relationship to the child victim; disbursement request is based; by the child victim, and the names and addresses of those giving any medical and hospitalization treatment to the child victim; household income; burial expenses, including any applicable taxes, surcharges, and fees; Department of reports, documents and other information relating to matters specified under this Act and rules adopted in accordance with this Act; and reasonably requires.
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