HomeMy WebLinkAbout20131847.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of JUNE 2013
SECTION I: GENERAL INFORMATION
Telephone Calls
908
Office (Public Contacts)
275
Home Visits
Outreach Visits (i.e. NH...)
1
Community Events/Forums
1
Request for Medals
Operation Recognition
8
Request for Medical Treatment Records
21-4142
12
Correspondence Received
101
Correspondence Written
127
Information and Referral/Inquiries
98
Other (i.e: VCAA Notice Response)
31
State Benefit(s)
5
Request for Military Records 8 Corrections •
SF -180
16
DD 149
3
DO 293
NA 13075
4
Other( )
SECTON II: NEW CLAIMS INITIATED
(Provide number of new claims initiated for current reporting month]
Appointed Representative:
21-22 OVA
21
21-22 Other
21-526EZ
(SC - New/)
15
21-4138
(SC - Informal Claim)
7
214138
(SC - New Issue)
2
21-4138
(SC - Reopen)
21-4138
(SC -Increase)
214138
(SC - secondary/Aggiavalion)
214138
(SC - Reinstatement)
21-4138
(SC w/ IU)
21-8940
(IU)
21.4192
(IU - Employer)
21-4138
(SMC)
21-686c
21-526
21-527
686c
21-526/527 w/AM
21-4138 (Reinstatement)
EVR (Any)
21-8416
5655
Request for Waivers/Compromise:
21-4138
1
5655 (FSR)
1
Dependent Indemnity Compensation (DIC)
21-534
2
wlAccrued Benefits
2
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
Request for VA Healthcare
10-10 EZ
24
10-10 EZ-R
12
10-583
10-10d (CHAMPVA-Dependents)
1
10-7959a (CHAMPVA)
10-79590 (CHAMPVA - Insurance Cert
Vocational Rehabilitation
28-1900 CH 31
4
28-1900 (Independent Living Program)
3
Educational Assistance Programs
P/911 CH 33
8
VEAP CH 32
VNEra GI CH34
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
264555 (Housing Grant)
10-0103 (HISA Grant)
Medicaid Application Assistance
SSA Application Assistance
Other (Specify)
Other (Specify)
Other ((Specify)
et ix)<th,L `
7-07-'�-i
CVA-28 (Revised 9/12008)
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7-x'5 q 222/
SECTION II (Continued):
Burial Allowance
21-530
40-1330
21-2008
6
4
VA Home Loan
26-1800
26-1817
7
Homeless Veterans Claims Flied
SC
1
NSC
1
Incarcerated Veterans -
214193 Release/Reinstatement
214138 (Apportionment)
Appeals
NOD
VA 9
3
Claims for Insurance
29 -357
294364
29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
Requests wl VTF (Grant), # Vets Assisted
Rental Assistance
5
Utilities Assistance
4
Prescription Assistance / Other Medical
Food
Transportation
6
Clothing
Other
DRO Election
Review
Hearing
7
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 ,To na , 20 I3 from el O County:
Salary _ $5,033.21
Expenses
Office Space
Telephone _ $326.60
Office Supplies
Travel
Training Conference
Other
Other
Total _ $5,359.81
7-12-13
(Styria— Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CR2hereby certify the accuracy of the Report (CVA-26, revised 9/1/20(2011)
William F.
WELD
Garcia, Chair
JUL 172013
County Commissioner or Designee of
County
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
1355S. Colorado Blvd., Suite 113, Bldg C
Denver, CO 80222 CVA-26 (Revised 9/1/2006)
.20/3 - g'41
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