HomeMy WebLinkAbout20133210COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
WELD COUNTY AUGUST 2013
SECTION I: GENERAL INFORMATION
Telephone Calls
650
Office (Public Contacts)
145
Home Visits
Outreach Visits (i.e. NH...)
5
Community Events/Forums
2
Request for Medals
1
Operation Recognition
Request for Medical Treatment Records
21-4142
2
Correspondence Received
90
Correspondence Written
75
Information and Referral/Inquiries
73
Other (i.e: VCAA Notice Response)
40
State Benefit(s)
Request for Military Records & Corrections
SF -180
20
DD 149
1
DD 293
NA 13075
Other )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative:
21-22
CVA
25
21-22
Other
Claims for SC Entitlement:
21-526
(SC - New/)
12
21-4138
(SC - Informal Claim)
10
21-4138
(SC - New Issue)
20
21-4138
(SC - Reopen)
5
21-4138
(SC -Increase)
10
21-4138
(SC - Secondary/Aggravation)
21-4138
(SC - Reinstatement)
21-4138
(SC w/ IU)
21-8940
(IU)
5
21-4192
(IU - Employer)
21-4138
(SMC)
21-686c
4
Non Service Connected Pension:
21-526
8
21-527
5
686c
8
21-526/527 WI A&A
21-4138 (Reinstatement)
EVR (Any)
21-8416
5655
Request for Waivers/Compromise:
21-4138
5655 (FSR)
Dependent Indemnity Compensation (DIC)
21-534
4
w/ Accrued Benefits
1
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
2
2
Request for VA Healthcare
10-10 EZ
18
10-10 EZ-R
2
10-583
10-10d (CHAMPVA - Dependents)
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 30
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)
21-4502 (Auto Grant / Adaptive Equipment)
26-4555 (Housing Grant)
10-0103 (HISA Grant)
Medicaid Application Assistance
SSA Application Assistance
,
Other (Specify)
Other (Specify) 2013-3210
Other (Specify)
CVA-26 (Revised 8/2011)
VP oct)
ed; yi9
SECTION II (Continued):
William F. Garcia, Chair
Burial Allowance
21-530
3
40-1330
1
21-2008
1
VA Home Loan
26-1880 (Certificate of Eligibility)
1
26-1817
Homeless Veterans Claims Filed
SC
NSC
Incarcerated Veterans
21-4193 Release/Reinstatement
1
21-4138 (Apportionment)
Appeals
NOD
4
VA 9
2
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
Utilities Assistance
Prescription Assistance / Other Medical
Food
Transportation
Clothing
Other
DRO Election
Review
Hearing
1
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 AUGUST
Salary
Expenses
Office Space
Telephone 340
Office Supplies
Travel
Training Conference
Other
Other
2013
4,187
Total 4,527
C
(Signature of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRSS2-707, I hereby certify the accuracy of the Report (CVA-26, revised 8/2011):
County Commissioner or Designee of
Weld County Board of Commissioners County
11/18/20131 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 8/2011)
a0i3-3a/o
COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
WELD COUNTY OCTOBER 2013
SECTION I: GENERAL INFORMATION
Telephone Calls
749
Office (Public Contacts)
146
Home Visits
Outreach Visits Qe. NH...)
5
Community Events/Forums
6
Request for Medals
4
Operation Recognition
Request for Medical Treatment Records
21-4142
Correspondence Received
101
Correspondence Written
75
Information and Referral/Inquiries
73
Other (i.e: VCAA Notice Response)
40
State Benefit(s)
Request for Military Records & Corrections
SF -180
20
DD 149
1
DD 293
NA 13075
Other ( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative:
21-22 CVA
32
21-22 Other
Claims for SC Entitlement:
21-526
(SC - New/)
30
21-4138
(SC - Informal Claim)
20
21-4138
(SC - New Issue)
10
21-4138
(SC - Reopen)
5
21-4138
(SC - Increase
2
21-4138
(SC - secondary/Aggravation)
21-4138
(SC - Reinstatement)
21-4138
(SC w/ IU)
21-8940
(IU)
5
21-4192
(1U - Employer)
21-4138
(SMC)
21-686c
4
Non Service Connected Pension:
21-526
18
21-527
5
686c
8
21-526/527 w/ A&A
21-4138 (Reinstatement)
EVR (Any)
21-8416
5655
Request for Waivers/Compromise:
21-4138
5655 (FSR)
Dependent Indemnity Compensation (DiC)
21-534
4
wl Accrued Benefits
1
Death Pension / Widows Pension
21-534
2
w/ Accrued Benefits
2
Request for VA Healthcare
10-10 EZ
28
10-10 EZ-R
2
10-583
10-10d (CHAMPVA - Dependents)
10-7959a (CHAMPVA)
10-7959C (CHAMPVA - Insurance Cert
Vocational Rehabilitation
28-1900 CH 31
2
28-1900 (Independent Living Program)
Educational Assistance Programs
1
MGIB
CH 30
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)
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)
CVA-26 (Revised 8/2011)
SECTION II (Continued):
William F. Garcia, Chair
Burial Allowance
21-530
3
40-1330
1
21-2008
1
VA Home Loan
26-1880 (Certificate of Eligibility)
1
26-1817
Homeless Veterans Claims Filed
SC
NSC
Incarcerated Veterans
21-4193 Release/Reinstatement
1
21-4138 (Apportionment)
Appeals
NOD
4
VA 9
2
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
Utilities Assistance
Prescription Assistance / Other Medical
Food
1,000
Transportation
400
Clothing
Other
DRO Election
Review
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 OCTOBER 2013
Salary
Expenses
Office Space
Telephone 356
Office Supplies
Travel
Training Conference
Other
Other
4,187
Total 4,543
(Signature of County Veterans Service Officer)
(Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS );5,-707, I hereby certify the accuracy of the Report (CVA-26, revised 8/2011):
County Commissioner or Designee of
Weld County Board of Commissioners County
Date
11/18/2013_:
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 8/2011)
0&0/3.3a/o
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