HomeMy WebLinkAbout20131523.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of MAY 2013
SECTION I: GENERAL INFORMATION
Telephone Calls
1061
Office (Public Contacts)
295
Home Visits
Outreach Visits (i.e. NH...)
1
Community Events/Forums
1
Request for Medals
6
Operation Recognition
Request for Medical Treatment Records
21-4142
1
15
Correspondence Received
112
Correspondence Written
139
Information and Referral/Inquiries
98
Other (i.e: VCAA Notice Response)
57
State Benefit(s)
10
Request for Military Records & Corrections
SF -180
23
DD 149
1
DD 293
0
NA 13075
4
CRSC
3
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative:
21-22 CVA
22
21-22 Other
21-526
(SC - New/)
8
21-4138
(SC - Informal Claim)
7
21-4138
(SC - New Issue)
3
21-4138
(SC - Reopen)
1
21-4138
(SC - Increase)
1
21-4138
(SC - Sxmaary/nwravation)
21-4138
(SC - Reinstatement)
21-4138
(SC WI Ill)
21-8940
(IU)
1
21-4192
(IU - Employer)
21-4138
(SMC)
21-686c
21-526
21-527
686c
21-526/527 WI AM
21-4138 (Reinstatement)
EVR (Any)
21-8416
5655
Request for WaiverslCompromise:
21-4138
3
5655 (FSR)
Dependent Indemnity Compensation (DIC)
21-534
WI Accrued Benefits
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
1
Request for VA Healthcare
10-10 EZ
18
10-10 EZ-R
8
10-583
4
10-10d (CHAMPVA - Dependents)
5
10-7959a (CHAMPVA)
3
10-79590 (CHAMPVA - Insurance Cert
Vocational Rehabilitation
28-1900 CH 31
2
28-1900 (Independent Living Program)
Educational Assistance Programs
P/911 CH 33
11
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)
3
214502 (Auto Grant I Adaptive Equipment)
1
26-4555 (Housing Grant)
1
10-0103 (HISA Grant)
1
Medicaid Application Assistance
SSA Application Assistance
Other (Specify)
Other (Specify)
Other (Specify)
CVA-?"^--'_
2013-1523
SECTION II (Continued):
Burial Allowance
21-530
40-1330
21-2008
5
4
VA Home Loan
26-1800
26-1817
6
Homeless Veterans Claims Filed
SC
NSC
Incarcerated Veterans
21-4193 Release/Reinstatement
21-4138 (Apportionment)
IS
NOD
2
VA 9
2
Claims for Insurance
29 -357
294364
29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
Requests w/ VTF (Grant), I Vets Assisted
Rental Assistance
4
Utilities Assistance
2
Prescription Assistance / Other Medical
Food
8
Transportation
Clothing
Other
DRO Election
Review
2
Hearing
2
SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER
I hereby certify, the above captioned monthly report is true and accurate. I have beeq paid the following
amount(s) for the month of m4zi_c 20 i3 from W el d County:
Salary $ 5,606.00
Expenses _ $ -
Office Space _ $ -
Telephone $ 285.85
Office Supplies _ $ -
Travel _ $ 299.00
Training Conference _ $ 200.00
Other _ $ -
Other _ $ -
Total
$ 6,390.00
�-�-- 6-13 -13
(Sign prrt of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-7
C
William F.
WELD
1 hereby certify the accuracy of the Report (CVA-26, revised 9/1/200f 2011)
County Commissioner or Designee of
County
JUN 17 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 91/2006)
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