HomeMy WebLinkAbout20112927 COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of OCTOBER 2011
SECTION I: GENERAL INFORMATION
Telephone Calls 955 Correspondence Received 77
Office(Public Contacts) 205 Correspondence Written 89
Home Visits Information and Referral/Inquiries 35
Outreach Visits (i.e. NH...) 2 Other(i.e: VCAA Notice Response) 59
Community Events/Forums 2 State Benefit(s) 5
Request for Medals 3 Request for Military Records&Corrections
Operation Recognition SF-180 43
DD 149 1
Request for Medical Treatment Records DD 293
21-4142 I 17 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 47 21-534 1
21-22 Other 1 w/Accrued Benefits
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC- New/) 44 10-10 EZ 28
21-4138 (SC- Informal Claim) 5 10-10 EZ-R 5
21-4138 (SC - New Issue) 7 10-583
21-4138 (SC - Reopen) 2 10-10d (CHAMPVA- Dependents)
21-4138 (SC- Increase) 1 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 5 VN Era GI CH 34
21-527 22-5490 CH 35
686c Sel Reservist NG CH 1607
21-526/527 w/A&A 1 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) 1
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 1 Other(Specify)
w/Accrued Benefits
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SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 4 29-357
40-1330 2 29-4364
21-2008 29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
VA Home Loan
26-1800 9 Requests w/VTF (Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC 3 Food
NSC 1 Transportation
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD 5 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 c of: OCTOBER 2011
Salary 3576
Expenses 0
Office Space 0
Telephone 247.49
Office Supplies 59.5
Travel 0
Training Conference 0
Other 0
Other 0
Total _ 3882.99
//-/-)/
(Signat ounty 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 9/1/2012011)
County Commissioner or Designee of
Weld County
t 0V 0 i 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.
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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