HomeMy WebLinkAbout20120449.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of: WELD Month of: JANUARY 2012
SECTION I: GENERAL INFORMATION
Telephone Calls 652 Correspondence Received
Office (Public Contacts) 157
208 Correspondence Written 138
Home Visits Information and Referral/Inquiries 96
Outreach Visits (i.e. NH...) 3 Other(i.e: VCAA Notice Response) 76
Community Events/Forums 3 State Benefit(s)
5
(Request for Medals I 5I Request for Military Records &Corrections
Operation Recognition SF-180
23
DD 149 2
Request for Medical Treatment Records DD 293
21-4142 f 37I NA 13075
1
Other(
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Ap ointed Representative: Death Pension /Widows Pension
21-22 CVA I 36 21-534
21-22 Other 3
2 w/Accrued Benefits
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC- New/) 31 10-10 EZ 28
21-4138 (SC- Informal Claim) 14 10-10 EZ-R
21-4138 (SC - New Issue) 3 10-583 7
21-4138 (SC - Reopen) 3 10-10d (CHAMPVA- Dependents)
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) 1 Vocational Rehabilitation
21-8940 (IU) 28-1900 CH 31 I
21-4192 (IU - Employer) 28-1900 (Independent Living Program) 11
21-4138 (SMC)
21-686c Educational Assistance Programs
MGIB CH 30 1
Non Service Connected Pension: VEAP CH 32
21-526 2 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 I Medicaid Application Assistance
5655 (FSR) SSA Application Assistance
Other(Specify)
Dependent Indemnity Compensation (DIC) Other(Specify)
21-534 I Other(Specify)
w/Accrued Benefits
2012-0449 eftS\.� (.O1110)) 'f ACVA-26(Revised 9/1 2006)
7-10,- 1'a. k, AOOO I
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SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 I 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 I Requests w/VTF (Grant), #Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC I 5 Food
NSC 0 Transportation 12
Clothing
Incarcerated Veterans Other 8
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
INOD I 41 Review 4
VA 9 f 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 January
Salary _ $3,400.00
Expenses $ -
Office Space _ $ -
Telephone $ 236.00
Office Supplies _ $ -
Travel $ -
Training Conference _ $ -
Other $ -
Other $ -
Total — $3,636.00
(Signal o nity 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 9/1/200f 2011)
____T> ` \ County Commissioner or Designee of
Sean P. Conway, Chair C
Weld / County
FEB 1 5 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 .2002—0e/1/9
Denver, CO 80222 CVA-26(Revised 9/1/2006)
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