HomeMy WebLinkAbout20121212.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of APRIL_2012
SECTION I: GENERAL INFORMATION
Telephone Calls 659 Correspondence Received 96
Office (Public Contacts) 205 Correspondence Written 89
Home Visits Information and Referral/Inquiries 43
Outreach Visits (i.e. NH...) 2 Other(i.e: VCAA Notice Response) 144
Community Events/Forums 1 State Benefit(s) 15
(Request for Medals 4 Request for Military Records &Corrections
Operation Recognition SF-180 33
DD 149 1
Request for Medical Treatment Records DD 293 3
21-4142 42 NA 13075
Other(
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative: Death Pension!Widows Pension
21-22 CVA 59 21-534 8
21-22 Other w/Accrued Benefits
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC- New/) 48 10-10 EZ 21
21-4138 (SC - Informal Claim) 10-10 EZ-R
21-4138 (SC - New Issue) 5 10-583
21-4138 (SC - Reopen) 10-10d (CHAMPVA- Dependents) 1
21-4138 (SC - Increase) 4 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 2
21-4192 (IU - Employer) 28-1900 (Independent Living Program)
21-4138 (SMC)
21-686c Educational Assistance Programs
MGIB CH 30 3
Non Service Connected Pension: VEAP CH 32
21-526 5 VN Era GI CH 34
21-527 1 22-5490 CH 35
686c 3 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) 1
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
C� , eCorut), V P\ 2012-1212
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SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 2 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 3 Requests wl VTF (Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance 2
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC Food 5
NSC 2 Transportation 4
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD 1 Review 1
VA 9 1 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 April 2012
Salary _ $3,576.00
Expenses _n/a
Office Space _n/a
Telephone _ $216.00
Office Supplies _ $101.14
Travel _n/a
Training Conference _n/a
Other _n/a
Other _n/a
Total _ $3,893.14
- ..� S- / Z
(Signature of o • • ,e erans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 2 -707, I hereby certify the accuracy of the Report(CVA-26, revised 9/1/20i 2011)
Vl
County Commissioner or Designee of
William F. Garcia, Chair Pro-Tern
Weld County
MAY 1 4 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)
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