HomeMy WebLinkAbout20130902.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of: Weld Month of :MARCH 2013
SECTION I: GENERAL INFORMATION
Telephone Calls
930
Office (Public Contacts)
264
Home Visits
Outreach Visits (i.e. NH...)
2
Community Events/Forums
1
Request for Medals
4
Operation Recognition
Request for Medical Treatment Records
21-4142
19
Correspondence Received
97
Correspondence Written
104
Information and Referral/Inquiries
90
Other (i.e: VCAA Notice Response)
56
State Benefit(s)
6
Request for Military Records & Corrections
SF -180
17
DD 149
1
CD 293
NA 13075
Other ( )
SECTON II: NEW CLAIMS INITIATED
(Provide number of new claims initiated for current reporting month]
Ap
ointed Representative:
CVA
20
21-22
21-22
Other
Claims for SC Entitlement:
21-526
(SC - New/)
22
21-4138
(SC - Informal Claim)
21-4138
(SC - New Issue)
5
21-4138
(SC - Reopen)
21-4138
(SC - Increase)
21-4138
(SC - Secondary/Aggravatic')
21-4138
(SC - Reinstatement)
21-4138
(SC w/ IU)
1
21-8940
(IU)
21-4192
(IU - Employer)
1
21-4138
(SMC)
21-686c
2
Non Service Connected Pension:
21-526
4
21-527
686c
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
w/ Accrued Benefits
Death Pension I Widows Pension
21-534
1
w/ Accrued Benefits
Request for VA Healthcare
10-10 EZ
23
10-10 EZ-R
3
10-583
10-10d (CHAMPVA - Dependents)
2
10-7959a (CHAMPVA)
10-7959C (CHAMPVA - Insurance Cert
2
Vocational Rehabilitation
28-1900 CH 31
28-1900 (Independent Living Program)
Educational Assistance Programs
MGIB CH 30
VEAP CH 32
POST 9/11 CH 33
11
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)
2013-0902
Other (Specify)
CVA-26 (Revised 9/1/2006)
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SECTION II (Continued):
Burial Allowance
21-530
40-1330
21-2008
2
VA Home Loan
26-1800
26-1817
5
Homeless Veterans Claims Filed
SC
2
NSC
2
Incarcerated Veterans
Claims assistance
3
21-4138 (Apportionment)
Appeals
NOD
VA 9
6
Claims for Insurance
29 -357
29-4364
29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
Requests w/ VTF (Grant), # Vets Assisted
Rental Assistance
4
Utilities Assistance
3
Prescription Assistance / Other Medical
Food
15
Transportation
4
Clothing
Other
DRO Election
Review
6
Hearing
2
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 MARCH , 20 from _WELD
Salary
Expenses
Office Space
Telephone
Office Supplies
Travel
Training Conference
Other
Other
$3,713.83
$0.00
$0.00
$379.66
$61.12
$0.00
$0.00
$0.00
$0.00
Total _ $4,154.61
(Signatere& ounty Veterans Service Officer)
(Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify the accuracy of the Report (CVA-26, revised 9/1/20(2011)
County Commissioner or Designee of
William F. Garcia, Chair
WELD County
APR 1 0 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 91112006)
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