HomeMy WebLinkAbout20133088.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY OF WELD SEPTEMBER 2013
SECTION I: GENERAL INFORMATION
Telephone Calls
486
Office (Public Contacts)
125
Home Visits
Outreach Visits (i.e. NH...)
5
Community Events/Forums
3
Request for Medals
Operation Recognition
Request for Medical Treatment Records
21-4142
Correspondence Received
110
Correspondence Written
80
Information and Referral/Inquiries
40
Other (i.e: VCAA Notice Response)
13
State Benefit(s)
5
Request for Military Records & Corrections
SF -180
15
DD 149
DO 293
NA 13075
Other ( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Ap
ointed Representative:
21-22
CVA
20
21-22
Other
1
Claims for SC Entitlement:
21-526
(SC - New/)
5
21-4138
(SC - Informal Claim)
2
21-4138
(SC - New Issue)
18
21-4138
(SC - Reopen)
3
21-4138
(SC - Increase)
2
21-4138
(SC - soccridery/Awave!ion)
21-4138
iSC - Reinstatement)
21-4138
(SC w/ IU)
21-8940
(IU)
21-4192
(IU - Employer)
21-4138
(SMC)
21-686c
Non Service Connected Pension:
21-526
3
21-527
686c
21-526/527 WI A&A
21-4138 (Reinstatement)
EVR (Any)
21-8416
5655
Request for Waivers/Compromise:
21-4138
5655 (FSR)
Dependent Indemnity Compensation
(DIG)
21-534
WI Accrued Benefits
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
3
Request for VA Healthcare
10-10 EZ
24
10-10 EZ-R
2
10-583
10-10d (CHAMPVA - Dependents)
10-7959a (CHAMPVA)
10-7959C (CHAMPVA - Insurance Cert
Vocational Rehabilitation
28-1900 CH 31
28-1900 (Independent Living Program)
Educational Assistance Programs
MGIB CH 30
1
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) 2013-3088
Other (Specify)
cc: peonr 14)
l/if
CVA-26 (Revised 8/2011)
SECTION II (Continued):
Burial Allowance
21-530
40-1330
21-2008
VA Home Loan
26-1880 (Certificate of Eligibility)
26-1817
Homeless Veterans Claims Filed
SC
NSC
incarcerated Veterans
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals
NOD
VA 9
1
3
2
Claims for Insurance
29 -357
29-4364
29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
Requests WI VTF (Grant), # Vets Assisted
Rental Assistance
Utilities Assistance
Prescription Assistance / Other Medical
Food
500
Transportation
100
Clothing
Other
DRO Election
Review
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 SP_p - tl re`r , 20 \ from Ll,\ -P \ County:
Salary
Expenses
Office Space
Telephone 254.06
Office Supplies
Travel
Training Conference
Other
Other
2,200
Total 2,454.06
r
(Signature of County Veterans Service Officer)
/0 /S-13
(Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-`,f hereby certify the accuracy of the Report (CVA-26, revised 8/2011):
County Commissioner or Designee of
ramr,F:: Garcia, Chair, Board of Weld County Commissioners
Weld County
NOV042013 4 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 fonn is to be submitted by the 15th clay 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 8/2011)
cz/s-gag
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