HomeMy WebLinkAbout20122475.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of _AUGUST 2012
SECTION I : GENERAL INFORMATION
Telephone Calls 665 Correspondence Received 94
Office (Public Contacts) 218 Correspondence Written 82
Home Visits Information and Referral/Inquiries 73
Outreach Visits (i . e. NH . . . ) 3 Other (i. e: VCAA Notice Response) 45
Community Events/Forums 2 State Benefit(s) 12
Request for Medals 9 Request for Military Records & Corrections
Operation Recognition SF- 180 22
DD 149 2
Request for Medical Treatment Records DD 293
21 -4142 I 31 NA 13075 3
Other ( )
SECTON II : NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative : Death Pension I Widows Pension
21 -22 CVA /34 21 -534 3
21 -22 Other 2 w/ Accrued Benefits 2
Claims for SC Entitlement: Request for VA Healthcare
21 -526 (SC - New/) 32 10- 10 EZ 23
21 -4138 (SC - Informal Claim) 2 10-10 EZ-R 8
21 -4138 (SC - New Issue) 10-583
21 -4138 (SC - Reopen) 10- 10d (CHAMPVA - Dependents)
21 -4138 (SC - Increase) 3 10-7959a (CHAMPVA)
214138 (SC - Secondary/Aggravation) 10-7959C (CHAMPVA - Insurance Cert
21 -4138 (SC - Reinstatement)
21 -4138 (SC w/ IU) 1 Vocational Rehabilitation
21 -8940 (IU) 2 28- 1900 CH 31 3
21 -4192 (IU - Employer) 28-1900 (Independent Living Program)
21 -4138 (SMC)
21 -686c 4 Educational Assistance Programs
MGIB CH 30
Non Service Connected Pension : VEAP CH 32
21 -526 4 VN Era GI CH 34
21 -527 22-5490 CH 35
686c Sel Reservist NG CH 1607
21 -526/527 w/ A&A 1 21 -674
21 -4138 (Reinstatement)
EVR (Any) Miscellaneous Claims
21 -8416 5 21 -8678 (Clothing Allowance)
5655 21 -4502 (Auto Grant / Adaptive Equipment)
26-4555 (Housing Grant)
Request for Waivers/Compromise: 10-0103 (HISA Grant)
21 -4138 2 Medicaid Application Assistance
5655 (FSR) 2 SSA Application Assistance
Other (Specify)
Dependent Indemnity Compensation (DIG) Other (Specify)
21 -534 1 Other (Specify)
WI Accrued Benefits 1
CVA-26 (Revised 9/12006)
QQJ . 3\tiAclon5) O1 2012-2475
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SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 5 29 -357
40-1330 29-4364
21-2008 29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
VA Home Loan
26-1800 7 Requests wl VTF (Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC 3 Food
NSC 2 Transportation
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD 6 Review 6
VA 9 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 Qvq(s t , 20 from (il/e I County:
Salary _ $4,187.00
Expenses $0.00
Office Space $0.00
Telephone _ $334.00
Office Supplies $0.00
Travel $0.00
Training Conference _ $0.00
Other $0.00
Other $0.00
w.uu
Total $4,521.00
9477-2-
(Signataryeterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify the accuracy of the Report (CVA-26, revised 9/1/2012011)
County Commissioner or Designee of
Sean P. Conway, Chair
Weld County
CEP 1 2 2n12 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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