HomeMy WebLinkAbout20122940.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of SEPTEMBER 2012
SECTION I: GENERAL INFORMATION
Telephone Calls 709 Correspondence Received 103
Office (Public Contacts) 274 Correspondence Written 80
Home Visits Information and Referral/Inquiries 78
Outreach Visits (i.e. NH...) 5 Other(i.e: VCAA Notice Response) 62
Community Events/Forums 2 State Benefit(s)
Request for Medals 7 Request for Military Records &Corrections
Operation Recognition SF-180 26
DD 149
Request for Medical Treatment Records
21-4142 I 30 NA 13075
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 27 21-534 2
21-22 Other w/Accrued Benefits 1
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 25 10-10 EZ 23
21-4138 (SC - Informal Claim) 10-10 EZ-R 6
21-4138 (SC - New Issue) 10-583
21-4138 (SC - Reopen) 10-10d (CHAMPVA- Dependents)
21-4138 (SC - Increase) 10-7959a (CHAMPVA)
21-4138 (SC -Secondary/Aggravation) 10-7959C (CHAMPVA- Insurance Cert
21-4138 (SC - Reinstatement)
21-4138 (SC w/ IU) 2 Vocational Rehabilitation
21-8940 (IU) 28-1900 CH 31
21-4192 (IU - Employer) 28-1900 (Independent Living Program)
21-4138 (SMC)
21-686c 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 21-674
21-4138 (Reinstatement)
EVR (Any) Miscellaneous Claims
21-8416 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 Medicaid Application Assistance
5655 (FSR) SSA Application Assistance
Other(Specify)
Dependent Indemnity Compensation (DIC) Other(Specify)
21-534 1 Other(Specify) 2012-2940
w/Accrued Benefits 1
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SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 8 29 -357
40-1330 5 29-4364
21-2008 29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
VA Home Loan
26-1800 3 Requests wl VTF (Grant), #Vets Assisted
26-1817 Rental Assistance 4
Utilities Assistance 5
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC 3 Food
NSC 2 Transportation
Clothing
Incarcerated Veterans Other 2
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD 3 Review 3
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 SEPTMBER 2012
Salary $4,005.11
Expenses
Office Space
Telephone $459.00
Office Supplies
Travel
Training Conference
Other
Other
Total 4465.11
In—le - 1 2_
(Signat ounty Veterans 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 9/1/20i 2011)
County Commissioner or Designee of
n P. Conway, Chair
Weld County
OCT 1 7 2012 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 }7r,��/ =72-Pr
Denver, CO 80222 CVA-26(Revised 9/1/2006)
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