HomeMy WebLinkAbout20130176.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of DECEMBER 2012
SECTION 1: GENERAL INFORMATION
Telephone Calls
687
Office (Public Contacts)
200
Home Visits
Outreach Visits (i.e. NH...)
4
Community Events/Forums
1
Request for Medals
3
Operation Recognition
1
Request for Medical Treatment Records
21-4142
19
Correspondence Received
64
Correspondence Written
80
Information and ReferraUlnquiries
Other (i.e: VCAA Notice Response)
47
State Benefit(s)
Request for Military Records & Corrections
SF -180
13
DD 149
4
DO 293
NA 13075
Other ( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Ap kited Representative:
21-22
CVA
26
21-22
Other
21-526
(SC - New/)
20
21-4138
(SC - Informal Claim)
1
21-4138
(SC - New Issue)
5
X21-4138
(SC - Reopen)
21-4138
(SC - Increase)
21-4138
(SC - Seconaary!Aggra,ai,on)
21-4138
(SC - Reinstatement)
21-4138
(SC w/ IU)
21-8940
(IU)
21-4192
(IU - Employer)
21-4138
(SMC)
21-686c
- 2
Non Service Connected Pension:
21-526
21-527
686c
21-526/527 wl A&A
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 / Widows Pension
21-534
wl Accrued Benefits
Request for VA Healthcare
10-10 EZ
16
10-10 EZ-R
3
10-583
10-10d (CHAMPVA - Dependents)
1
10-7959a (CHAMPVA)
10-7959C (CHAMPVA - Insurance Cert
Vocational Rehabilitation
28-1900 CH 31
2
28-1900 (Independent Living Program)
Educational Assistance Programs
MGIB CH 33
15
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)
1
21-4502 (Auto Grant / Adaptive Equipment)
1
26-4555 (Housing Grant)
10-0103 (HISA Grant)
1
Medicaid Application Assistance
SSA Application Assistance
Other (Specify)
Other (Specify)
Other (Specify)
CVA-26 (Revised 9/1/2006)
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2013-0176
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SECTION II (Continued):
Burial Allowance
21-530
2
40-1330
4
21-2008
VA Home Loan
26-1800
3
26-1817
Homeless Veterans Claims Filed
SC
NSC
Incarcerated Veterans
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals
NOD
5
VA 9
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
6
Utilities Assistance
6
Prescription Assistance / Other Medical
Food
10
Transportation
4
Clothing
Other
DRO Election
Review
5
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 DECEMBER
Salary
Expenses
Office Space
Telephone
Office Supplies
Travel
Training Conference
Other
Other
$ 3,823.06
$ 250.40
$ 97.64
Total $4,171 64
(Signatur ounty Veterans Service Officer)
WELD CO.
- SCI
(Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CS�
lie /d
eby certify the accuracy of the Report (CVA-26, revised 9/1/200E 2011)
County Commissioner or Designee of
County
JAN 1 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 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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