HomeMy WebLinkAbout20130410.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD
Month of JANUARY 2013
SECTION I: GENERAL INFORMATION
Telephone Calls
850
Office (Public Contacts)
200
Home Visits
Outreach Visits (i.e. NH...)
1
Community Events/Forums
Request for Medals
8
Operation Recognition
Request for Medical Treatment Records
21-4142
17
Correspondence Received
96
Correspondence Written
150
Information and Referral/Inquiries
120
Other (i.e: VCAA Notice Response)
54
State Benefit(s)
Request for Military Records & Corrections
SF -180
30
DD 149
1
DD 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
24
21-22
Other
21-526
(SC - New/)
22
21-4138
(SC - Informal Claim)
21-4138
(SC - New Issue)
2
21-4138
(SC - Reopen)
21-4138
(SC - Increase)
p
21-4138
(SC - SecontlarylAppra,alion)
21-4138
(SC - Reinstatement)
21-4138
(SC w/ IU)
21-8940
(IU)
21-4192
(IU - Employer)
21-4138
(SMC)
21-686c
1
Non Service Connected Pension:
21-526
1
21-527
1
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 (DIG)
21-534
1
wl Accrued Benefits
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
F
2
Request for VA Healthcare
10-10 EZ
21
10-10 EZ-R
3
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
P/911 CH 33
12
VRAP
8
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)
CC . (tTricj
2013-0410
N roc \
SECTION II (Continued):
Burial Allowance
21-530
40-1330
21-2008
VA Home Loan
26-1800
26-1817
7
Homeless Veterans Claims Filed
SC
NSC
2
Incarcerated Veterans
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals
NOD
VA 9
2
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
Utilities Assistance
Prescription Assistance / Other Medical
Food
2
Transportation
Clothing
Other
DRO Election
Review
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 January , 2013 from Weld Co:
Salary
Expenses
Office Space
Telephone $ 528.38
Office Supplies
Travel
Training Conference
Other
Other
$ 4, 085.22
Total $4,613 60
i
(Si a ure of County Veterans Service Officer)
(Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-7DJ-f herby certify the accuracy of the Report (CVA-26, revised 9/1/200(2011)
County Commissioner or Designee of
F. Garcia, Chair
Weld County
FEB 1 1 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 9/1/2006)
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