HomeMy WebLinkAbout20123279.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of OCTOBER 2012
SECTION I: GENERAL INFORMATION
Telephone Calls 817 Correspondence Received 40
Office (Public Contacts) 263 Correspondence Written 67
Home Visits Information and Referral/Inquiries 108
Outreach Visits(i.e. NH...) 1 Other (i.e: VCAA Notice Response) 80
Community Events/Forums 2 State Benefit(s) 8
Request for Medals 6 Request for Military Records&Corrections 1
Operation Recognition SF-180
DD 149 18
, Request for Medical Treatment Records DO 293 3
21-4142 1 28 NA 13075
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 37 21-534 1
21-22 Other wl Accrued Benefits
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 33 10-10 EZ 24
21-4138 (SC - Informal Claim) 10-10 EZ-R
21-4138 (SC - New Issue) 1 10-583
21-4138 (SC - Reopen) 10-10d (CHAMPVA- Dependents)
21-4138 (SC - Increase) 5 10-7959a (CHAMPVA)
21-4138 (SC - SecondaryiAggrava,cr) 10-7959C (CHAMPVA- Insurance Cert
21-4138 (SC - Reinstatement)
21-4138 (SC w/ IU) Vocational Rehabilitation
21-8940 (IU) 28-1900 CH 31
21-4192 (IU -Employer) 28-1900 (Independent Living Program)
21-4138 (SMC)
21-686c 1 Educational Assistance Programs
MGIB CH 33 12
Non Service Connected Pension: VEAP CH 32
21-526 3 VN Era GI CH 34
21-527 1 22-5490 CH 35
686c Sel Reservist NG CH 1607
21-526/527 w/A&A 21-674 1
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 Other(Specify)
wl Accrued Benefits
2012-3279
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SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 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 Requests w/VTF (Grant),#Vets Assisted
26-1817 Rental Assistance 3
Utilities Assistance 1
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC Food
9
NSC Transportation 4
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD 1 Review 1
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 C - b. , 20?from County:
Salary _ $3,823.06
Expenses
Office Space
Telephone _ $347 42
Office Supplies
Travel
Training Conference
Other
Other
Total _ $4,170.48
( ure 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 9/1/20(2011)c
County Commissioner or Designee of
Sean P. Conway, Chair (
Weld \ County
NOV 1 9 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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