Death Benefits Trust Funds
As set forth in Mississippi Code Annotated §45-2-1 and §45-2-31, the Mississippi Department of Public Safety shall be responsible for the management and disbursement of benefits under the Law Enforcement Officers and Fire Fighters Death Benefits Trust as well as the Other Safety Officials Death Benefits Trust. Please refer to the Law Enforcement Officers and Fire Fighters Death Benefits Trust and Other Safety Officials Death Benefits Trust Memorandum for a more detailed explanation of the death benefits, definitions of key terms, and specific instructions for completing the required Trust Fund forms.
The following forms have been developed to assist the process of establishing beneficiaries, claiming death benefits, and applying for funeral expenses.
Law Enforcement Officers and Fire Fighters Death Benefits Trust Fund:
The Law Enforcement Officers and Fire Fighters Death Benefits Trust Fund was established to provide death benefits when a law enforcement officers or fire fighter dies or receives an accidental or intentional fatal bodily injury while performing their official duties.
- Beneficiary Designation (Form DB-010) – The Beneficiary Designation Form (Form DB-010) should be completed by law enforcement officers or firefighters, including volunteer firefighters, who are “covered individuals” as defined in the statute, in order to name a beneficiary or beneficiaries for receiving the benefit. The form should be signed and notarized by the covered individual and placed within the public employer’s or agency’s personnel file wherein the person is currently employed.
- Death Benefits Trust Claim Application (Form DB-020) – The Death Benefits Trust Claim Application (Form DB-020) should be completed by the chief law enforcement officer or public agency director, as “Employer” for the deceased individual. This form shall be completed upon the death of the covered individual and submitted to MDPS, along with the Beneficiary Designation Form if one exists.
- Application for Payment of Funeral and Other Related Burial Expenses (Form DB-030) – The Application for Payment of Funeral and Other Related Burial Expenses Payment (Form DB-030) should be completed in part by the deceased individual’s next of kin and in part by the chief law enforcement officer or public agency director, as “Employer” for the deceased individual. Upon completion, this form should be submitted by the Employer to MDPS.
Other Safety Officials Death Benefits Trust Fund:
The Other Safety Officials Death Benefits Trust Fund was established to provide death benefits when directors and assistant directors of local emergency management organizations as well as coroners and deputy coroners are accidentally or intentionally killed while engaged in the performance of their official duties.
- Beneficiary Designation (Form OS-010) – The Beneficiary Designation Form (Form OS-010) should be completed by directors and assistant directors of local emergency management organizations as well as coroners and deputy coroners in order to name a beneficiary or beneficiaries for receiving the benefit. The form should be signed and notarized by the covered individual and placed within the public employer’s or agency’s personnel file wherein the person is currently employed.
- Death Benefits Trust Claim Application (Form OS-020) – The Death Benefits Trust Claim Application (Form OS-020) should be completed by the County or public agency director as the employer for the deceased individual. This form shall be completed upon the death of the covered individual and submitted to MDPS, along with the Beneficiary Designation Form if one exists.
If you have any questions or concerns, please contact DeathBenefitsTrust@dps.ms.gov for assistance.