HomeMy WebLinkAbout20112411.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of Weld Month of August 2011
SECTION I: GENERAL INFORMATION
Telephone Calls 245 Correspondence Received 9
Office (Public Contacts) 148 Correspondence Written 65
Home Visits Information and Referral/Inquiries 80
Outreach Visits (i.e. NH...) 5 Other(i.e: VCAA Notice Response) 3
Community Events/Forums 2 State Benefit(s) 2
Request for Medals Request for Military Records&Corrections
Operation Recognition SF-180 18
DD 149
Request for Medical Treatment Records DD 293 2
21-4142 I 11 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 27 21-534 1
21-22 Other w/Accrued Benefits
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 21 10-10 EZ 18
21-4138 (SC - Informal Claim) 10-10 EZ-R
21-4138 (SC - New Issue) 45 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) 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 1 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 Other(Specify)
w/Accrued Benefits
�} J CVA-26(Revised 9/1/2006)
cc VA000(
2 -15- 11 2011-2411
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 wl VTF (Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC Food
NSC Transportation
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD Review
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 August 2011
Salary $3,406.00
Expenses
Office Space
Telephone $128.00
Office Supplies
Travel $100.00
Training Conference
Other
Other
Total $3,634.00
9- 6 — 7
(Signature of County Veterans ervice Officer) (Date)
)UNTY COMMISSIONER OR DESIGNEE
In accordance with C,RS 28-5-707, I hereby certify the accuracy of the Report(CVA-26, revised 9/1/20I9/1/2012011)
'
zJf
L /� t -.L2L— County Commissioner or Designee of
Barbara Kirkmey r, Chair
Weld County
9/12/2011 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.
Kt 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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