HomeMy WebLinkAbout20120670.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of FEBRUARY 2012
SECTION I: GENERAL INFORMATION
Telephone Calls 724 Correspondence Received 97
Office (Public Contacts) 195 Correspondence Written 110
Home Visits Information and Referral/Inquiries 89
Outreach Visits (i.e. NH...) 3 Other(i.e: VCAA Notice Response) 122
Community Events/Forums 1 State Benefit(s) 3
Request for Medals Request for Military Records&Corrections
Operation Recognition SF-180 23
DD 149 1
Request for Medical Treatment Records DD 293 1
21-4142 I 33 NA 13075
2
Other( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Ap a ointed Representative: Death Pension/Widows Pension
21-22 CVA 42 21-534 5
21-22 Other w/Accrued Benefits 2
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC- New/) 39 10-10 EZ 22
21-4138 (SC - Informal Claim) 8 10-10 EZ-R 3
21-4138 (SC- New Issue) 1 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) 2 28-1900 CH 31 1
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 VN Era GI CH 34
21-527 22-5490 CH 35
686c Sel Reservist NG CH 1607
21-526/527w/A&A 4 21-674
21-4138 (Reinstatement)
EVR (Any) 4 Miscellaneous Claims
21-8416 4 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 Other(Specify)
w/Accrued Benefits
2012-0670
3-\3-‘a (/
SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 4 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 6 Requests wl VTF (Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC 3 Food
NSC Transportation
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD Review 2
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 February 2012 Weld
Salary $3,576.00
Expenses
Office Space
Telephone $ 242.28
Office Supplies
Travel
Training Conference
Other
Other
Total $3,818.28
'3—s—/z
(Signature of County 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 9/1/200(2011)
County Commissioner or Designee of
Sean P. Conway
C
Weld County
MAR 1 2 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
Denver, CO 80222 CVA-26(Revised 9/1/2006)!
Hello