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Home My WebLink About20132340.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY COUNTY of WELD Month of JULY 2013 SECTION I: GENERAL INFORMATION Telephone Calls 1033 Office (Public Contacts) 252 Home Visits Outreach Visits (i.e. NH...) 1 Community Events/Forums 1 Request for Medals Operation Recognition 9 Request for Medical Treatment Records 21-4142 j 42 Correspondence Received 111 Correspondence Written 167 Information and Referral/Inquiries 98 Other (i.e: VCAA Notice Response) 49 State Benefit(s) 6 Request for Military Records & Corrections SF -180 18 DD 149 4 DO 293 NA 13075 1 Other ( ) SECTON II: NEW CLAIMS INITIATED [Provide number of new claims initiated for current reporting month] Ap ointed Representative: 21-22 CVA 30 21-22 Other 21-526EZ (SC - New/) 8 21-4138 (SC - Informal Claim) 20 21-4138 (SC - New Issue) 2 21-4138 (SC - Reopen) 1 21-4138 (SC - Increase) 21-4138 (SC - Secondary/Aggravation) 21-4138 (SC - Reinstatement) 21-4138 (SC w/ IU) 21-8940 (IU) 3 21-4192 (IU - Employer) 1 21-4138 (SMC) 21-686c Nsc Pension 21-526 21-527 2 686c 2 21-526/527 w/ A&A 1 21-4138 (Reinstatement) EVR (Any) 21-8416 5655 Request for Waivers/Compromise: 21-4138 5655 (FSR) Dependent Indemnity Compensation (DIC) 21-534 wl Accrued Benefits cc : 1/X Death Pension / Widows Pension 21-534 4 w/ Accrued Benefits Request for VA Healthcare 10-10 EZ 17 10-10 EZ-R 10-583 10-10d (CHAMPVA - Dependents) 2 10-7959a (CHAMPVA) 1 10-7959C (CHAMPVA - Insurance Cert Vocational Rehabilitation 28-1900 CH 31 28-1900 (Independent Living Program) Educational Assistance Programs 16 P/911 CH 33 VEAP CH 32 VN Era GI CH 34 22-5490 CH 35 Sel Reservist NG CH 1607 21-674 Miscellaneous Claims 21-8678 (Clothing Allowance) 21-4502 (Auto Grant / Adaptive Equipment) 26-4555 (Housing Grant) 10-0103 (HISA Grant) Medicaid Application Assistance SSA Application Assistance Other (Specify) Other (Specify) Other (Specify) Drs'!!;rid to `✓ . e CVA-26 (Revised 9/1/2006) 2013-2340 ///4 Obi©/ SECTION II (Continued): Burial Allowance 21-530 5 40-1330 5 21-2008 VA Home Loan 26-1800 26-1817 Homeless Veterans Claims Filed SC 1 NSC 1 incarcerated Veterans 21-4193 Release/Reinstatement 21-4138 (Apportionment) Appeals NOD 4 VA 9 Claims for Insurance 29 -357 29-4364 29-336 (Designation of Beneficiary) 21-4125 (Claim for Lump Sum Payment) Requests wl VTF (Grant), # Vets Assisted Rental Assistance 2 Utilities Assistance 3 Prescription Assistance / Other Medical Food Transportation 4 Clothing Other DRO Election Review 4 Hearing SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER I hereby certify, the above captioned monthly report is true and accurate. I have been paid the following amount(s) for the month of v , 20 i 3 from t ie l r) Salary -David & Deon Expenses Office Space Telephone Office Supplies Travel Training Conference Other Other Total r-� $4,887.53 $0.00 $0.00 $386.01 $240.42 $0.00 $0.00 $0.00 $0.00 $5,513.96 8-14/-i3 County: (Signatounty Veterans Service Officer) (Date) SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE In accordance with CRS- 5}70 , I hereby certify the accuracy of the Report (CVA-26, revised 9/1/20( 2011) County Commissioner or Designee of Willia f`arcia, Chair WELD County AUG 1 G 2013 Date This certification, submitted monthly, properly signed and executed, will be considered as application for the monetary benefits to the County General Fund, in accordance with 28-5-804 (2002) Colorado Revised Statue. This form is to be submitted by the 15th day of the following month. Mail to: Colorado Division of Veterans Affairs Attention: Director Bill Conroy 1355 S. Colorado Blvd., Suite 113, Bldg C Denver, CO 80222 CVA-26 (Revised 9/12006) &O/3-431/0 Hello